Individual
WILLIAM JOHN SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
6222 S MOFFAT FARM LN, SALT LAKE CITY, UT 84121-6713
(970) 590-3773
Mailing address
6222 S MOFFAT FARM LN, SALT LAKE CITY, UT 84121-6713
(970) 590-3776
(801) 290-2466
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
9475918-3102
UT
363LF0000X
Family Nurse Practitioner
Primary
9475918-4405
UT
Other
Enumeration date
08/23/2018
Last updated
01/22/2019
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