Healthcare Provider Details

I. General information

NPI: 1356283121
Provider Name (Legal Business Name): NP 360 CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 W 8760 S
WEST JORDAN UT
84088-9397
US

IV. Provider business mailing address

1755 W 8760 S
WEST JORDAN UT
84088-9397
US

V. Phone/Fax

Practice location:
  • Phone: 801-930-0333
  • Fax: 385-304-4749
Mailing address:
  • Phone: 801-930-0333
  • Fax: 385-304-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONNA KICIN
Title or Position: OWNER
Credential: AGPCNP-BC
Phone: 801-930-0333