Individual
RENEE A VADEBONCOEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-BC
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) 587-5572
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
223122-4405
UT
363LA2200X
Adult Health Nurse Practitioner
223122-4405
UT
363LF0000X
Family Nurse Practitioner
Primary
223122-4405
UT
363LP0200X
Pediatric Nurse Practitioner
223122-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100503073
—
NV
05
—
29303796
—
NM
05
—
806407400
—
ID
01
—
9461
UNIVERSITY HEALTH PLANS
—
05
—
D4591
—
UT
05
—
NP655UT
—
AK
Enumeration date
05/09/2006
Last updated
12/20/2021
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