Healthcare Provider Details

I. General information

NPI: 1851626980
Provider Name (Legal Business Name): KATHLEEN RODMAN FNP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 DOUGLAS ST
SALT LAKE CITY UT
84102-2610
US

IV. Provider business mailing address

255 DOUGLAS ST
SALT LAKE CITY UT
84102-2610
US

V. Phone/Fax

Practice location:
  • Phone: 801-583-9639
  • Fax: 801-583-9639
Mailing address:
  • Phone: 801-583-9639
  • Fax: 801-583-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number193462-4405
License Number StateUT

VIII. Authorized Official

Name: MS. KATHLEEN C RODMAN
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 801-583-9639