MEDICARE: EDWIN O AWINDA APRN

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	363L00000X	Nurse Practitioner	7321629-4405	UT
2	363LG0600X	Gerontology Nurse Practitioner	7321629-8900	UT

General Provider Information

NPI Number	:	1194216895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN O AWINDA APRN

Provider Business Mailing Address
First Line	:	120 W 1300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-5230
Country	:	US
Telephone Number	:	801-486-4877
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 S GREEN ST STE A
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-5632
Country	:	US
Telephone Number	:	801-486-4877
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	02/10/2026

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