Basic Information
| Provider Information | |||||||||
| NPI: | 1548579147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIVERTSEN | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5250 S 320 W | ||||||||
| Address2: | ATRIUM BLDG, STE 305 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841077926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012627246 | ||||||||
| FaxNumber: | 8012623696 | ||||||||
| Practice Location | |||||||||
| Address1: | 5250 S 320 W | ||||||||
| Address2: | ATRIUM BLDG, STE 305 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841077926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012627246 | ||||||||
| FaxNumber: | 8012623696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2010 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 7774047-1206 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 7774047-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.