Provider Demographics
NPI:1457682866
Name:MEHINOVIC, DZENIS (CRNA)
Entity Type:Individual
Prefix:
First Name:DZENIS
Middle Name:
Last Name:MEHINOVIC
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3570
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3570
Mailing Address - Country:US
Mailing Address - Phone:801-727-2056
Mailing Address - Fax:770-701-6675
Practice Address - Street 1:9660 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3762
Practice Address - Country:US
Practice Address - Phone:801-727-2056
Practice Address - Fax:770-701-6675
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118812367500000X
UT084069367500000X
UT5158976-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00878101OtherRAILROAD MEDICARE
TX8200UAOtherBLUE CROSS BLUE SHIELD
TX212653401Medicaid
TX212653401Medicaid