Provider Demographics
NPI:1982668414
Name:SANDBERG, REBECCA W (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:W
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:APRN, FNP
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 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-397-6200
Mailing Address - Fax:801-397-6201
Practice Address - Street 1:185 S 400 E
Practice Address - Street 2:STE 100
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4801
Practice Address - Country:US
Practice Address - Phone:801-397-6200
Practice Address - Fax:801-397-6201
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT196335-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000092656Medicare PIN
UT19633544002001OtherBLUE ID
UTALTIUSOther240829
UTPEHPOther22804
UT107006940104OtherIHC ID
UTP14754Medicare UPIN