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NPI Code Detail

MEDICARE: BRANDI BOLTON-ORR FNP

MEDICARE: BRANDI BOLTON-ORR FNP
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
1364SF0001XFamily Health Clinical Nurse Specialist1963434405UT
2363LF0000XFamily Nurse Practitioner196343-4405UT

General Provider Information

NPI Number : 1811176761
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI BOLTON-ORR FNP
Provider Business Mailing Address
First Line : 2116 NEW HORIZON DR
Second Line :
City : SANDY
State : UT
Zip : 84093-2691
Country : US
Telephone Number : 801-558-5514
Fax Number :
Provider Business Practice Location Address
First Line : 2000 S 900 E
Second Line :
City : SLC
State : UT
Zip : 84105-3208
Country : US
Telephone Number : 801-464-7660
Fax Number : 801-464-7558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2007
Last Update Date : 06/14/2023

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