Provider Demographics
NPI:1861413742
Name:SCHEIDELL, RENEE NILSSON (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:NILSSON
Last Name:SCHEIDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12272 S 800 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9789
Mailing Address - Country:US
Mailing Address - Phone:801-523-1300
Mailing Address - Fax:801-523-1301
Practice Address - Street 1:12272 S 800 E
Practice Address - Street 2:SUITE 100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9789
Practice Address - Country:US
Practice Address - Phone:801-523-1300
Practice Address - Fax:801-523-1301
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1883021205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005586901Medicare ID - Type Unspecified
UTF66884Medicare UPIN