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General NPI Number Information
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NPI Number | 1386441996
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Entity Type | Individual
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Provider Name | TEGAN GRUNWALD
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Gender | Female
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Dates
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Enumeration Date | 03/01/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3115 E LION LN STE 160
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City | SALT LAKE CITY
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State | UT
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Zip | 84121
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Country | US
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Telephone | 855-255-1750
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Fax | 855-255-0905
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Provider Business Mailing Address
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Address Line | 2177 S NOWELL CIR
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2869
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Country | US
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Telephone | 541-760-0032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12627832-4405
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License Number State | UT
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