Healthcare Provider Details

I. General information

NPI: 1073652145
Provider Name (Legal Business Name): BARBARA PATTERSON REINEKE FNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 7000 S
WEST JORDAN UT
84084-3431
US

IV. Provider business mailing address

1371 BROWNING AVE
SALT LAKE CITY UT
84105-2601
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-9133
  • Fax: 801-569-9103
Mailing address:
  • Phone: 801-582-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2084264405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: