Active NPI
Matthew Kanenwisher, RN
- General Practice Registered Nurse
- American Fork, UT
National Provider Identifier
1104232834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- 8274851-3102
- Practice address
- 464 N 680 W
American Fork, UT 84003-3103 - Phone
- (801) 369-1709
- NPI assigned
- Jul 2, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 8274851-3102 | UT | Primary |
Addresses
Primary practice location
464 N 680 W
American Fork, UT 84003-3103
Mailing address
464 N 680 W
American Fork, UT 84003-3103
Phone (801) 369-1709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8274851-3102 | UT | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581292800000",
"number": "1104232834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "464 N 680 W",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840033103",
"telephone_number": "801-369-1709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 N 680 W",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840033103",
"telephone_number": "801-369-1709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANENWISHER",
"first_name": "MATTHEW",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-02",
"last_updated": "2020-02-10",
"certification_date": "2020-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "UT",
"license": "8274851-3102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in American Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.