Provider Demographics
NPI:1194216895
Name:AWINDA, EDWIN O (APRN)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:O
Last Name:AWINDA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 S WRIGHT CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2914
Mailing Address - Country:US
Mailing Address - Phone:801-941-4034
Mailing Address - Fax:813-366-8463
Practice Address - Street 1:4035 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1866
Practice Address - Country:US
Practice Address - Phone:801-262-9181
Practice Address - Fax:813-336-8463
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7321629-8900363LG0600X
UT7321629-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner