Provider Demographics
NPI:1124678164
Name:BJORKMAN, REBECCA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:BJORKMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3698 W OAK CREST DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6625
Mailing Address - Country:US
Mailing Address - Phone:801-319-5986
Mailing Address - Fax:
Practice Address - Street 1:11520 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7805
Practice Address - Country:US
Practice Address - Phone:385-887-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8648998-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily