Healthcare Provider Details

I. General information

NPI: 1053302406
Provider Name (Legal Business Name): ELIZABETH MARY KATOMSKI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W 700 S
SALT LAKE CITY UT
84101-2227
US

IV. Provider business mailing address

1661 BLAINE AVE
SALT LAKE CITY UT
84105-3802
US

V. Phone/Fax

Practice location:
  • Phone: 801-537-7537
  • Fax: 801-363-3140
Mailing address:
  • Phone: 801-486-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2759003102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: