MEDICARE: MRS. KRISTIN KAY BRADBURY-KRISTENSEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SN0000X	Neonatal Clinical Nurse Specialist	327855-4405	UT

General Provider Information

NPI Number	:	1770853558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN KAY BRADBURY-KRISTENSEN NP

Provider Business Mailing Address
First Line	:	PO BOX 30180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0180
Country	:	US
Telephone Number	:	801-662-4183
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84113-1103
Country	:	US
Telephone Number	:	801-662-4183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	05/17/2021

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