Provider Demographics
NPI:1093582074
Name:GREENWOOD, NIKKI P (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:P
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 S COMMERCE DR STE E190
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5321
Mailing Address - Country:US
Mailing Address - Phone:801-266-2000
Mailing Address - Fax:877-896-8171
Practice Address - Street 1:5280 S COMMERCE DR STE E190
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5321
Practice Address - Country:US
Practice Address - Phone:801-266-2000
Practice Address - Fax:877-896-8171
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7346558-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner