=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659397545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE M. KENDALL APRN, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1403 E SEGO LILY DR STE 100
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84092-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-265-2212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 35380
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89133-5380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-954-7672
-----------------------------------------------------
Fax | 801-501-4099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 212106-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------