Individual
HEATHER BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
2000 CIRCLE OF HOPE DR # 4146, SALT LAKE CITY, UT 84112-5550
(801) 803-4175
Mailing address
2000 CIRCLE OF HOPE DR # 4146, SALT LAKE CITY, UT 84112-5550
(801) 803-4175
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
8248067-4405
UT
363LF0000X
Family Nurse Practitioner
F07180626
OK
Other
Enumeration date
09/18/2018
Last updated
10/21/2021
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