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J. DAYNE PETERSEN M.D. PC NPI 1346597507


NPI Information

NPI: 1346597507
Provider Name: J. DAYNE PETERSEN M.D., PC

Doing Business As: NUVISTA PLASTIC SURGERY

Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 46D2056118

Address:
5353 S 960 E
#150
SALT LAKE CITY, UT
ZIP 84117
Phone: (801) 261-5791
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J. DAYNE PETERSEN M.D., PC is a medical specialty clinic center in Salt Lake City, UT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). J. DAYNE PETERSEN M.D., PC NPI is 1346597507. The provider is registered as an organization entity type.
The provider Is Doing Business As Nuvista Plastic Surgery.

The provider's business location address is:

5353 S 960 E
#150
SALT LAKE CITY, UT
ZIP 84117-569
Phone: (801) 261-5791
Fax: (801) 747-7740

The provider's authorized official is Jason Dayne Petersen .
The authorized official title is President and has the following contact phone number (801) 971-8684.

The CLIA number assigned to this NPI record is 46D2056118 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/7/2012 and was last updated on 8/30/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM2500XClinic/CenterMedical Specialty83185641205UTAHYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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