Healthcare Provider Details

I. General information

NPI: 1346793940
Provider Name (Legal Business Name): JENNA KRISTINE ROBINSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA KRISTINE FANKHAUSER RN

II. Dates (important events)

Enumeration Date: 07/31/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST STE 510
MURRAY UT
84107-6767
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3513
  • Fax:
Mailing address:
  • Phone: 801-507-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6994455-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6994455-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: