Healthcare Provider Details

I. General information

NPI: 1275984254
Provider Name (Legal Business Name): CASSANDRA RENEE DEBENHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 01/14/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7661 S 700 E
MIDVALE UT
84047-2350
US

IV. Provider business mailing address

7661 S 700 E
MIDVALE UT
84047-2350
US

V. Phone/Fax

Practice location:
  • Phone: 801-385-5243
  • Fax:
Mailing address:
  • Phone: 801-385-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number7574219-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: