Provider Demographics
NPI:1639826043
Name:YOUR IN HOME NP
Entity Type:Organization
Organization Name:YOUR IN HOME NP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH-ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SAMPSON-SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:385-212-4358
Mailing Address - Street 1:358 S 700 EAST
Mailing Address - Street 2:STE B #333
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1446
Mailing Address - Country:US
Mailing Address - Phone:385-212-4358
Mailing Address - Fax:
Practice Address - Street 1:3269 S MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3767
Practice Address - Country:US
Practice Address - Phone:385-212-4358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain