Healthcare Provider Details

I. General information

NPI: 1629276423
Provider Name (Legal Business Name): SUSAN MARGARET KIRBY APRN MS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FOOTHILL DR LEVEL ONE
SALT LAKE CITY UT
84112-1106
US

IV. Provider business mailing address

1608 S 600 E
SALT LAKE CITY UT
84105-2007
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6431
  • Fax: 801-585-5294
Mailing address:
  • Phone: 801-521-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2002574405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: