Healthcare Provider Details

I. General information

NPI: 1871587121
Provider Name (Legal Business Name): TERRY LEE SCHOENWALD WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRY LEE AUGUSTINE

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 4500 S #200
SALT LAKE CITY UT
84107-3906
US

IV. Provider business mailing address

3101 ELK RUN DR
PARK CITY UT
84098-5300
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-9800
  • Fax: 801-262-8300
Mailing address:
  • Phone: 801-721-9487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3784544405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: