MEDICARE: MRS. HEIDI AASE WINEGAR MSN, APRN, AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	6158919-4405	UT

General Provider Information

NPI Number	:	1063251460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI AASE WINEGAR MSN, APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	4331 W 9580 S
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-9646
Country	:	US
Telephone Number	:	801-856-4982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 440
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84124-1349
Country	:	US
Telephone Number	:	801-869-4100
Fax Number	:	801-869-4119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/28/2024

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