# PIONEER COMPREHENSIVE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891975595
- **Authorized official:** ROBIN OLSEN (OFFICE MANAGER)
- **Authorized official phone:** (801) 576-1086

## Contact information

- **Practice address:** 12433 FORT ST, DRAPER, UT 84020-9363
- **Practice address phone:** (801) 576-1086
- **Practice address fax:** (801) 576-9796
- **Mailing address:** 12433 FORT ST, DRAPER, UT 84020-9363
- **Mailing address phone:** (801) 576-1086
- **Mailing address fax:** (801) 576-9796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 891818251205 | UT | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/09/2007
- **Last updated:** 01/02/2024