Provider Demographics
NPI:1386485621
Name:PEDERSEN, MATHEW CHRISTOPHER (DNP FNP-BC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:CHRISTOPHER
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:DNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 E SHADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2892
Mailing Address - Country:US
Mailing Address - Phone:801-888-7495
Mailing Address - Fax:
Practice Address - Street 1:1748 W 1800 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8324
Practice Address - Country:US
Practice Address - Phone:180-177-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8677181-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner