Healthcare Provider Details

I. General information

NPI: 1194989228
Provider Name (Legal Business Name): SAMYE PATRICIA KLINE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E STE 240
SALT LAKE CITY UT
84121-1720
US

IV. Provider business mailing address

5965 S 900 E STE 240
SALT LAKE CITY UT
84121-1720
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-7100
  • Fax:
Mailing address:
  • Phone: 801-263-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2761843102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: