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General NPI Number Information
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NPI Number | 1972936326
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Entity Type | Individual
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Provider Name | WHITNEY JEAN MENTABERRY APRN
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Gender | Female
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 65 E TWIN PEAKS ST
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City | MIDVALE
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State | UT
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Zip | 84047-1215
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Country | US
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Telephone | 801-568-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 S 400 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2204
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Country | US
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Telephone | 775-722-7355
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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 | 7254248-4405
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License Number State | UT
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