Individual provider Active NPI

Rena Holverson, APRN

  • Nurse Practitioner
  • Salt Lake City, UT
National Provider Identifier
1376569798
Registry record updated Jan 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2022784405 Issued in UT
Practice address
400 C St
Salt Lake City, UT 84143-1005
Phone
(801) 408-1100
NPI assigned
Jul 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2022784405 UT Primary

Addresses

Primary practice location

400 C St
Salt Lake City, UT 84143-1005

Mailing address

401 S 400 E
Bountiful, UT 84010-4933
Phone (801) 408-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060503000342 UT Practitioner - Nurse Practitioner 1052321171 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2022784405UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Silverton Group LLC CurrentSince Nov 1, 2016 Accepting new patients

Locations

401 S 400 E
Bountiful, UT 84010
Phone (801) 295-2361

8th Ave And C St
Salt Lake City, UT 84143
Phone (801) 350-4110

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1376569798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S 400 E",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104933",
            "telephone_number": "801-408-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 C ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841431005",
            "telephone_number": "801-408-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLVERSON",
        "first_name": "RENA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-15",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "2022784405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.