Healthcare Provider Details

I. General information

NPI: 1831289461
Provider Name (Legal Business Name): KIRSTEN L STOESSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 WILMINGTON AVE
SALT LAKE CITY UT
84106-2819
US

IV. Provider business mailing address

1138 WILMINGTON AVE
SALT LAKE CITY UT
84106-2819
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2000
  • Fax: 801-463-0313
Mailing address:
  • Phone: 801-581-2000
  • Fax: 801-463-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4803532-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: