MEDICARE: KATHERINE NICOLE VANDENBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	14220768-1205	UT

General Provider Information

NPI Number	:	1013440189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE NICOLE VANDENBERG M.D.

Provider Business Mailing Address
First Line	:	6686 S HIGHLAND DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3037
Country	:	US
Telephone Number	:	801-937-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	6686 S HIGHLAND DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3037
Country	:	US
Telephone Number	:	801-937-9650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	02/11/2026

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