Healthcare Provider Details

I. General information

NPI: 1013464726
Provider Name (Legal Business Name): SANDRA BURKINSHAW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N SUITE 300
AMERICAN FORK UT
84003-2956
US

IV. Provider business mailing address

1248 E 90 N SUITE 300
AMERICAN FORK UT
84003-2956
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-9635
  • Fax:
Mailing address:
  • Phone: 801-756-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5350349-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: