Healthcare Provider Details

I. General information

NPI: 1568135937
Provider Name (Legal Business Name): SARA J KUNZE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 SHIELDS LN #101
SOUTH JORDAN UT
84095
US

IV. Provider business mailing address

1694 E KELMSCOTT CT APT B
SLC UT
84124-2576
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7611629-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: