Provider Demographics
NPI:1124989611
Name:ANIRON FUNCTIONAL MEDICINE AND INTEGRATIVE PSYCHIATRY
Entity type:Organization
Organization Name:ANIRON FUNCTIONAL MEDICINE AND INTEGRATIVE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:469-443-4130
Mailing Address - Street 1:195 N STATE ST STE 150B
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2256
Mailing Address - Country:US
Mailing Address - Phone:469-443-4130
Mailing Address - Fax:469-945-0005
Practice Address - Street 1:195 N STATE ST STE 150B
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2256
Practice Address - Country:US
Practice Address - Phone:469-443-4130
Practice Address - Fax:469-945-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty