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General NPI Number Information
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NPI Number | 1043851116
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Entity Type | Individual
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Provider Name | KENZLEE WOODEN
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 845 S MAIN ST STE A7
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6482
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Country | US
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Telephone | 801-298-0903
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Fax |
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Provider Business Mailing Address
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Address Line | 5671 S 650 E
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City | WASHINGTON TERRACE
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State | UT
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Zip | 84405-1201
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Country | US
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Telephone | 801-678-2518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9158154-8900
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License Number State | UT
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