Healthcare Provider Details

I. General information

NPI: 1376112888
Provider Name (Legal Business Name): KALI CONDIE TSUHAKO WHNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KALI CONDIE

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N TRIUMPH BLVD STE 210
LEHI UT
84043-7187
US

IV. Provider business mailing address

585 N 500 W
PROVO UT
84601-1548
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-1577
  • Fax: 801-216-8357
Mailing address:
  • Phone: 385-985-5357
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11311452-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number11311452
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11311452
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: