| NPI | 1104244938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KEVIN VISKER Administrator 801-210-0506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: UT 264688-8900) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| 363LG0600X Nurse Practitioner Gerontology (Licence: UT 264688-8900) | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2025-08-14 |