Provider Demographics
NPI:1467698084
Name:BOTCHWAY, BENJAMIN N (APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:N
Last Name:BOTCHWAY
Suffix:
Gender:M
Credentials: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 1:1798 N STALLION LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-1115
Mailing Address - Country:US
Mailing Address - Phone:801-440-8233
Mailing Address - Fax:801-886-0956
Practice Address - Street 1:1640 W 500 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-5202
Practice Address - Country:US
Practice Address - Phone:801-886-0930
Practice Address - Fax:801-886-0956
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT337207-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily