Healthcare Provider Details

I. General information

NPI: 1285736926
Provider Name (Legal Business Name): MARIE KATHLEEN ACREE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 4500 S SUITE 300
SALT LAKE CITY UT
84107-2900
US

IV. Provider business mailing address

650 E 4500 S SUITE 300
SALT LAKE CITY UT
84107-2900
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3500
  • Fax:
Mailing address:
  • Phone: 801-261-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number1981078900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: