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General NPI Number Information
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NPI Number | 1245032432
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Entity Type | Individual
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Provider Name | DONNA L KICIN
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Gender | Female
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 1755 W 8760 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-9397
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Country | US
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Telephone | 385-267-3951
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Fax | 385-304-4749
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Provider Business Mailing Address
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Address Line | 1755 W 8760 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-9397
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Country | US
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Telephone | 385-267-3951
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Fax | 385-304-4749
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 10496682-3102
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 104966824408
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License Number State | UT
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