Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 215065-4405 | UT |
NPI | 1336323336 |
---|---|
Provider Name | Dr. Kristine Antonelli Karlsen |
First Address | Salt Lake City, UT 84113-1103 |
Second Address | Park City, UT 84098-5851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 09/07/2009 |