Healthcare Provider Details

I. General information

NPI: 1689595969
Provider Name (Legal Business Name): MEGAN A WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

1730 E WILSON AVE
SALT LAKE CITY UT
84108-2917
US

V. Phone/Fax

Practice location:
  • Phone: 713-204-7418
  • Fax:
Mailing address:
  • Phone: 713-204-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number12340903-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: