Healthcare Provider Details

I. General information

NPI: 1669400552
Provider Name (Legal Business Name): SHERI L BANGERTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 W 13400 S
RIVERTON UT
84096-6419
US

IV. Provider business mailing address

4651 W 13400 S
RIVERTON UT
84096-6419
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-9700
  • Fax: 801-254-6680
Mailing address:
  • Phone: 801-254-9700
  • Fax: 801-254-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number291159-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number291159-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: