MEDICARE: MARILYN JEAN KLEIN FNPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	UT2229454405	UT

General Provider Information

NPI Number	:	1023018017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN JEAN KLEIN FNPC

Provider Business Mailing Address
First Line	:	14 WESTWOOD RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4901
Country	:	US
Telephone Number	:	435-649-2989
Fax Number	:

Provider Business Practice Location Address
First Line	:	1670 BONANZA DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7205
Country	:	US
Telephone Number	:	435-649-5989
Fax Number	:	435-649-5991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2005
Last Update Date	:	07/08/2007

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