Doctor Name: | KIMBERLY MORTENSON |
NPI Number: | 1083705735 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 2756754405 |
Business Practice Address: | 48 N 1100 E Suite C American Fork, UT - 840032910 |
Business Phone Number: | 8014924933 |
Business Fax Number: | 8014924371 |
Mailing Address: | 48 N 1100 E, Suite C AMERICAN FORK |
State: | UT |
Postal Code: | 840032910 |
Phone Number: | 8014924933 |
Fax Number: | 8014924371 |
NPI Enumeration Date: | 09/27/2006 |
NPI Last Update Date: | 12/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SF0001X |
License Number: | 2756754405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Family Health |
Taxonomy Definition: |