Provider Demographics
NPI:1336140821
Name:VAN ZANT, JIM W (RN,CS)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:W
Last Name:VAN ZANT
Suffix:
Gender:M
Credentials:RN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 N 900 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9183
Mailing Address - Country:US
Mailing Address - Phone:801-763-4173
Mailing Address - Fax:801-763-4073
Practice Address - Street 1:895 N 900 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-9183
Practice Address - Country:US
Practice Address - Phone:801-763-4173
Practice Address - Fax:801-763-4073
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT852132134405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS63108Medicare UPIN