Healthcare Provider Details

I. General information

NPI: 1386202950
Provider Name (Legal Business Name): KAITLYNN NAOKO URANO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLYNN NAOKO LOFTHOUSE AUD

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 N 1100 E STE 203
AMERICAN FORK UT
84003-2941
US

IV. Provider business mailing address

98 N 1100 E STE 203
AMERICAN FORK UT
84003-2941
US

V. Phone/Fax

Practice location:
  • Phone: 319-936-3294
  • Fax:
Mailing address:
  • Phone: 319-936-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number11288009-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: