Individual
BRENDA MUEGGENBORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.N.P.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
PO BOX 581700, SALT LAKE CITY, UT 84158-1700
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
324632-4405
UT
363LA2200X
Adult Health Nurse Practitioner
324632-4405
UT
363LP0200X
Pediatric Nurse Practitioner
324632-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0437223
—
MT
01
—
32463244000001
REGENCE BCBS OF UTAH #
—
01
—
500019103
MEDICARE RAILROAD #
—
01
—
58298
PEHP #
—
05
—
806014400
—
ID
01
—
8101
UNIVERSITY HEALTH PLANS #
—
01
—
887303
DMBA #
—
05
—
D3855
—
UT
01
—
QM0000037482
ALTIUS #
—
Enumeration date
05/10/2006
Last updated
11/08/2021
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