Peggy Grusendorf, APRN
Nurse Practitioner, Family in Provo, UT. Individual provider (NPI-1).
NPI number1528296928
StatusActive
Last updated in NPPESJun 24, 2009
Details
- NPI
- 1528296928
- Entity type
- Individual (NPI-1)
- Name
- Ms. Peggy Grusendorf
- Credential
- APRN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 24, 2009
- Last updated
- Jun 24, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2057812073 | UT | Yes |
Practice location
1300 E Center StProvo, UT 84606-3554
Phone 801-344-4204 · Fax 801-344-4291
Mailing address
1300 E Center StProvo, UT 84606-3554
Phone 801-344-4204 · Fax 801-344-4291
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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