IndividualActive
Bonnie Wallace, FNP-C
NPI 1871316372 · Family Nurse Practitioner · Herriman, UT
Provider details
- NPI number
- 1871316372
- Entity type
- Individual
- Primary specialty
- Family Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- FNP-C
- Sex
- Female
- Sole proprietor
- Yes
- License
- 7682759-4405 (UT)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
12573 S Liberty Hill Ct
Herriman, UT 84096-7774
Phone: (801) 690-4899
Approximate (ZIP-level) locationGet directions
Mailing address
12573 S Liberty Hill Ct
Herriman, UT 84096-7774
Registry dates
- Enumerated
- 2024-11-04
- Last updated
- 2024-11-04
- Certified
- 2024-10-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.