Provider Demographics
NPI:1346474749
Name:NORDSTROM, BJORN A (DO)
Entity type:Individual
Prefix:
First Name:BJORN
Middle Name:A
Last Name:NORDSTROM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E MILL RD STE 303
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-5730
Mailing Address - Country:US
Mailing Address - Phone:801-224-1300
Mailing Address - Fax:801-224-1300
Practice Address - Street 1:707 E MILL RD STE 303
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-5730
Practice Address - Country:US
Practice Address - Phone:801-224-1301
Practice Address - Fax:801-225-3236
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT10191817-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10118OtherLICENSE