Healthcare Provider Details

I. General information

NPI: 1124931035
Provider Name (Legal Business Name): MARINA WILKINS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

IV. Provider business mailing address

716 S 800 E
BOUNTIFUL UT
84010-3828
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3414
  • Fax:
Mailing address:
  • Phone: 435-590-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8786902-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: