Provider Demographics
NPI:1871587121
Name:SCHOENWALD, TERRY LEE (WHCNP)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LEE
Last Name:SCHOENWALD
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:AUGUSTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3101 ELK RUN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5300
Mailing Address - Country:US
Mailing Address - Phone:801-721-9487
Mailing Address - Fax:
Practice Address - Street 1:348 E 4500 S
Practice Address - Street 2:#200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3906
Practice Address - Country:US
Practice Address - Phone:801-262-9800
Practice Address - Fax:801-262-8300
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3784544405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P72882Medicare UPIN