Provider Demographics
NPI:1538576673
Name:FAVERO, HEIDI (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:FAVERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:STE 3500
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:801-743-4750
Mailing Address - Fax:801-743-4765
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:STE 3500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1202
Practice Address - Country:US
Practice Address - Phone:801-743-4750
Practice Address - Fax:801-743-4765
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT354334-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care