Healthcare Provider Details

I. General information

NPI: 1235340019
Provider Name (Legal Business Name): GINA MARKOS CAPPS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DR
BOUNTIFUL UT
84010-4968
US

IV. Provider business mailing address

1199 S BONNEVILLE DR
SALT LAKE CITY UT
84108-2051
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-1464
  • Fax: 801-292-1465
Mailing address:
  • Phone: 801-583-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number97-200043-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: