MEDICARE: JANA KOHLER N.N.P

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	363LN0000X	Neonatal Nurse Practitioner	NP12929	CA
2	363LN0000X	Neonatal Nurse Practitioner	12099347-4405	UT

General Provider Information

NPI Number	:	1932132719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA KOHLER N.N.P

Provider Business Mailing Address
First Line	:	7259 S BINGHAM JUNCTION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4860
Country	:	US
Telephone Number	:	800-453-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	7259 S BINGHAM JUNCTION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4860
Country	:	US
Telephone Number	:	800-453-3030
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/03/2022

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