MEDICARE: WENDELL TODD SHRUM RN

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	282NC0060X	Critical Access Hospital	6949270-3102	UT

General Provider Information

NPI Number	:	1174932966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDELL TODD SHRUM RN

Provider Business Mailing Address
First Line	:	1360 E 5360 S
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-7361
Country	:	US
Telephone Number	:	205-305-6251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 E 5360 S
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-7361
Country	:	US
Telephone Number	:	205-305-6251
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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