MEDICARE: CHRISTY LYNN VAN ORMAN FNP-C

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	363LF0000X	Family Nurse Practitioner	285485-4405	UT

General Provider Information

NPI Number	:	1790413839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY LYNN VAN ORMAN FNP-C

Provider Business Mailing Address
First Line	:	500 S CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1221
Country	:	US
Telephone Number	:	801-584-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 S KOMAS DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1208
Country	:	US
Telephone Number	:	801-584-5144
Fax Number	:

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

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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