MEDICARE: SAMANTHA BOLTON DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	8510211-4402	UT
2	367A00000X	Advanced Practice Midwife	8510211-4402	UT
3	163W00000X	Registered Nurse	8510211-3102	UT

General Provider Information

NPI Number	:	1558059683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BOLTON DNP

Provider Business Mailing Address
First Line	:	10 S 2000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5880
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3723 W 12600 S STE 360
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7296
Country	:	US
Telephone Number	:	801-285-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	12/09/2025

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