Healthcare Provider Details

I. General information

NPI: 1548882160
Provider Name (Legal Business Name): YERAM STENSRUD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S GENEVA RD
OREM UT
84058-2217
US

IV. Provider business mailing address

221 FIELDSTONE DR
MELISSA TX
75454-2704
US

V. Phone/Fax

Practice location:
  • Phone: 801-437-0490
  • Fax:
Mailing address:
  • Phone: 626-714-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: