Healthcare Provider Details

I. General information

NPI: 1538665229
Provider Name (Legal Business Name): MEGAN A. SCHWARTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 S 8400 W
MAGNA UT
84044-4907
US

IV. Provider business mailing address

3665 S 8400 W
MAGNA UT
84044-4907
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-9638
  • Fax:
Mailing address:
  • Phone: 801-250-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number11437551-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number114377551-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: