Healthcare Provider Details

I. General information

NPI: 1790807790
Provider Name (Legal Business Name): CAROLEE SCHWENDIMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 LA JOYA DR
SALT LAKE CITY UT
84124-3739
US

IV. Provider business mailing address

2990 LA JOYA DR
SALT LAKE CITY UT
84124-3739
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-8274
  • Fax:
Mailing address:
  • Phone: 801-277-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number194294-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: