Provider Demographics
NPI:1730246299
Name:WOOTTON, GEORGE CHRISTOPHER (FNP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHRISTOPHER
Last Name:WOOTTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 OLD MAIN HILL
Mailing Address - Street 2:UTAH STATE UNIVERSITY
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-6802
Mailing Address - Country:US
Mailing Address - Phone:435-797-2750
Mailing Address - Fax:
Practice Address - Street 1:6802 OLD MAIN HL
Practice Address - Street 2:UTAH STATE UNIVERSITY
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-0001
Practice Address - Country:US
Practice Address - Phone:435-797-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT97-225360-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily