=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235282872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY MARIE RUSIN A.P.R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8278 S RESACA DR UNIT L9
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-2095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-898-1754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8278 S RESACA DR UNIT L9
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-2095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-898-1754
-----------------------------------------------------
Fax | 385-557-4282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 4757258-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------