MEDICARE: MICHELLE PINEDA

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	163W00000X	Registered Nurse	8061058-3102	UT

General Provider Information

NPI Number	:	1861006678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE PINEDA

Provider Business Mailing Address
First Line	:	2672 S GLENMARE ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3606
Country	:	US
Telephone Number	:	401-633-5831
Fax Number	:

Provider Business Practice Location Address
First Line	:	2672 S GLENMARE ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3606
Country	:	US
Telephone Number	:	401-633-5831
Fax Number	:

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

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	08/31/2020

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Directions to “ MICHELLE PINEDA ” Practice Location

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