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General NPI Number Information
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NPI Number | 1811660764
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Entity Type | Individual
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Provider Name | MERCEDES LONGSHAW MORTENSEN AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 522 E 100 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1905
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Country | US
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Telephone | 801-485-5055
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 S HARMONY CIR
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-2706
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Country | US
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Telephone | 925-262-7059
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 283800-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 283800-4405
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License Number State | UT
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