Provider Demographics
NPI:1669471421
Name:KRENSKY, BEVERLY A (FNP, BC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:KRENSKY
Suffix:
Gender:F
Credentials:FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 S 250 E
Mailing Address - Street 2:STE 405
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8113
Mailing Address - Country:US
Mailing Address - Phone:801-662-4949
Mailing Address - Fax:801-662-4931
Practice Address - Street 1:100 NORTH MEDICAL DRIVE
Practice Address - Street 2:PCMC OUTPATIENT REHAB
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113
Practice Address - Country:US
Practice Address - Phone:801-662-4949
Practice Address - Fax:801-662-4931
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327911-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005767002Medicare ID - Type Unspecified
UTQ21119Medicare UPIN