Healthcare Provider Details

I. General information

NPI: 1861313397
Provider Name (Legal Business Name): EMILY REBECCA MCWIDENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 S 1300 E
SANDY UT
84094-5553
US

IV. Provider business mailing address

9450 S 1300 E
SANDY UT
84094-5553
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-2131
  • Fax: 801-571-1689
Mailing address:
  • Phone: 801-501-2131
  • Fax: 801-571-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number5177353-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: