Healthcare Provider Details

I. General information

NPI: 1265400568
Provider Name (Legal Business Name): CHRISTINE W KAPSA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E 100 S SUITE 400
SALT LAKE CITY UT
84102-1501
US

IV. Provider business mailing address

1060 E 100 S SUITE 400
SALT LAKE CITY UT
84102-1501
US

V. Phone/Fax

Practice location:
  • Phone: 801-521-2640
  • Fax: 801-363-6407
Mailing address:
  • Phone: 801-521-2640
  • Fax: 801-363-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number981964744405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: