Provider Demographics
NPI:1245989763
Name:WENTWORTH, CHERYL ANN (APRN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:WENTWORTH
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 1:3680 N 2175 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2428
Mailing Address - Country:US
Mailing Address - Phone:385-215-5007
Mailing Address - Fax:
Practice Address - Street 1:498 N 900 W
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4137
Practice Address - Country:US
Practice Address - Phone:385-382-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8194969-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily