Healthcare Provider Details

I. General information

NPI: 1033024724
Provider Name (Legal Business Name): KAITLIN MAGNUSSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13033 S 2730 W
RIVERTON UT
84065-6388
US

IV. Provider business mailing address

13033 S 2730 W
RIVERTON UT
84065-6388
US

V. Phone/Fax

Practice location:
  • Phone: 801-557-4091
  • Fax:
Mailing address:
  • Phone: 801-557-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: