MEDICARE: MRS. MERCEDES LONGSHAW MORTENSEN AGNP-C

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	363LA2200X	Adult Health Nurse Practitioner	283800-4405	UT
2	363LG0600X	Gerontology Nurse Practitioner	283800-4405	UT

General Provider Information

NPI Number	:	1811660764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERCEDES LONGSHAW MORTENSEN AGNP-C

Provider Business Mailing Address
First Line	:	3204 S HARMONY CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2706
Country	:	US
Telephone Number	:	925-262-7059
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 E 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1905
Country	:	US
Telephone Number	:	801-485-5055
Fax Number	:

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	07/30/2025

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