Provider Demographics
NPI:1407441280
Name:SCHLENTZ, MICHELLE LYN (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYN
Last Name:SCHLENTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E 4500 S STE 130
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4034
Mailing Address - Country:US
Mailing Address - Phone:801-792-0424
Mailing Address - Fax:
Practice Address - Street 1:2200 E 4500 S STE 130
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4034
Practice Address - Country:US
Practice Address - Phone:801-792-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6812043-4405208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6812043-4405OtherAPRN