Provider Demographics
NPI:1609268317
Name:WILEY, NATHAN (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:WILEY
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 W 7000 S STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3556
Mailing Address - Country:US
Mailing Address - Phone:801-263-0717
Mailing Address - Fax:801-266-2362
Practice Address - Street 1:1561 W 7000 S STE 200
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-263-0717
Practice Address - Fax:801-266-2362
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8927878-3102163W00000X
UT8927878-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse