MEDICARE: MS. SONJA J BATES APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277543-4405	UT

General Provider Information

NPI Number	:	1699868950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONJA J BATES APRN

Provider Business Mailing Address
First Line	:	PO BOX 17963
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-0963
Country	:	US
Telephone Number	:	801-674-6376
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 BISHOP FEDERAL LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2357
Country	:	US
Telephone Number	:	801-487-7557
Fax Number	:	801-487-1112

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	10/21/2021

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