Healthcare Provider Details

I. General information

NPI: 1093115289
Provider Name (Legal Business Name): IRENE P.N. CHEONG DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N 1950 W SUITE # 201
SALT LAKE CITY UT
84116-3098
US

IV. Provider business mailing address

168 N 1950 W #201
SALT LAKE CITY UT
84116-3098
US

V. Phone/Fax

Practice location:
  • Phone: 801-671-2263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5340135-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5340135-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number5340135-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: