Provider Demographics
NPI:1114124732
Name:NURSE PRACTITIONER HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:NURSE PRACTITIONER HEALTHCARE ASSOCIATES
Other - Org Name:NPHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STILLION-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,MS, C-FNP
Authorized Official - Phone:801-274-6127
Mailing Address - Street 1:4568 HIGHLAND DR
Mailing Address - Street 2:SUITE # 290
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4263
Mailing Address - Country:US
Mailing Address - Phone:801-274-6127
Mailing Address - Fax:801-274-6129
Practice Address - Street 1:4568 HIGHLAND DR
Practice Address - Street 2:SUITE # 290
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4263
Practice Address - Country:US
Practice Address - Phone:801-274-6127
Practice Address - Fax:801-274-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care