Healthcare Provider Details

I. General information

NPI: 1720846884
Provider Name (Legal Business Name): MCKENNA LYNN TSCHAGGENY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENNA LYNN CRAIG APRN

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

518 E WILSON AVE
SALT LAKE CITY UT
84105-2912
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number9807590-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number9807590-3102
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9807590-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: