Healthcare Provider Details

I. General information

NPI: 1013986710
Provider Name (Legal Business Name): KIMBERLY A SPANGRUDE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 E RUTLAND PL
COTTONWOOD HEIGHTS UT
84121-5829
US

IV. Provider business mailing address

2233 E. MAIN ST. BUSINESS OPTIONS MEDICAL BILLING
MONTROSE CO
81401-3831
US

V. Phone/Fax

Practice location:
  • Phone: 801-971-1739
  • Fax:
Mailing address:
  • Phone: 970-765-0810
  • Fax: 970-497-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0991964-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223145-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: