Healthcare Provider Details

I. General information

NPI: 1982051785
Provider Name (Legal Business Name): PATRICIA M STARKS APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA M DURSTELER APRN,

II. Dates (important events)

Enumeration Date: 05/21/2016
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2678 S GLENMARE ST
SALT LAKE CITY UT
84106-3606
US

IV. Provider business mailing address

2678 S GLENMARE ST
SALT LAKE CITY UT
84106-3606
US

V. Phone/Fax

Practice location:
  • Phone: 801-583-5854
  • Fax:
Mailing address:
  • Phone: 801-583-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344443-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number344443-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number344443-4405
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number344443-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: