Healthcare Provider Details

I. General information

NPI: 1063251460
Provider Name (Legal Business Name): HEIDI AASE WINEGAR MSN, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 440
SLC UT
84124-1349
US

IV. Provider business mailing address

4331 W 9580 S
SOUTH JORDAN UT
84009-9646
US

V. Phone/Fax

Practice location:
  • Phone: 801-869-4100
  • Fax: 801-869-4119
Mailing address:
  • Phone: 801-856-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6158919-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: