Healthcare Provider Details

I. General information

NPI: 1881884252
Provider Name (Legal Business Name): KATIE ANN TOLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ANN HURLEY APN

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 E 2100 S SUITE 4
SALT LAKE CITY UT
84106-2060
US

IV. Provider business mailing address

1053 E 2100 S
SALT LAKE CITY UT
84106-2060
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-3995
  • Fax: 801-359-8489
Mailing address:
  • Phone: 801-359-3995
  • Fax: 801-359-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTAPN700363
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: