Provider Demographics
NPI:1174932966
Name:SHRUM, WENDELL TODD (RN)
Entity type:Individual
Prefix:
First Name:WENDELL
Middle Name:TODD
Last Name:SHRUM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E 5360 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7361
Mailing Address - Country:US
Mailing Address - Phone:205-305-6251
Mailing Address - Fax:
Practice Address - Street 1:1360 E 5360 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7361
Practice Address - Country:US
Practice Address - Phone:205-305-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6949270-3102282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access