Healthcare Provider Details

I. General information

NPI: 1548510431
Provider Name (Legal Business Name): LIANA OLIVIA KINIKINI DNP, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3895 W 7800 S SUITE 100
WEST JORDAN UT
84088-5617
US

IV. Provider business mailing address

3895 W 7800 S SUITE 100
WEST JORDAN UT
84088-5617
US

V. Phone/Fax

Practice location:
  • Phone: 801-280-7774
  • Fax: 801-748-2790
Mailing address:
  • Phone: 801-280-7774
  • Fax: 801-748-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4777852-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4777852-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: