Provider Demographics
NPI:1326735549
Name:SLIM & TRIM MEDICAL ONLINE
Entity Type:Organization
Organization Name:SLIM & TRIM MEDICAL ONLINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUVER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:435-554-8637
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-0308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S COBBLE TER
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:UT
Practice Address - Zip Code:84325-9756
Practice Address - Country:US
Practice Address - Phone:435-554-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202204361NP-PPOtherBOARD OF NURSING
ID66272OtherBOARD OF NURSING
UT12369693-4405OtherDIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING