Healthcare Provider Details

I. General information

NPI: 1669669388
Provider Name (Legal Business Name): THERESA K KULIKOWSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 S WOODROW STREET SUITE 200
MURRAY UT
84107-5841
US

IV. Provider business mailing address

1134 EAST 3300 SOUTH #313
SLC UT
84106
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-1020
  • Fax: 801-747-1023
Mailing address:
  • Phone: 719-205-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5140165-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: