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NPI Code Detail

MEDICARE: MS. TRISHA LYNN BANDEKA-BENNETT RN

MEDICARE: MS. TRISHA LYNN BANDEKA-BENNETT 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
1163W00000XRegistered Nurse5683071-3102UT

General Provider Information

NPI Number : 1295713436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRISHA LYNN BANDEKA-BENNETT RN
Provider Business Mailing Address
First Line : 1166 E 500 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-3806
Country : US
Telephone Number : 801-718-1216
Fax Number :
Provider Business Practice Location Address
First Line : 3944 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-1600
Country : US
Telephone Number : 801-261-1442
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 07/08/2007

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