Healthcare Provider Details

I. General information

NPI: 1982411674
Provider Name (Legal Business Name): KATHERINE JEAN SARDONI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 W 12600 S STE 230
RIVERTON UT
84065-7270
US

IV. Provider business mailing address

125 E 1ST AVE APT 207
SALT LAKE CITY UT
84103-2376
US

V. Phone/Fax

Practice location:
  • Phone: 801-252-6116
  • Fax: 801-508-2787
Mailing address:
  • Phone: 435-531-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11601175-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: