Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP30004331 | WA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 50963944405 | UT |
N | 363LP0200X | Nurse Practitioner - Pediatrics | AP30004331 | WA |
NPI | 1225021934 |
---|---|
Provider Name | Kristie K Marbut |
First Address | Salt Lake City, UT 84106-1521 |
Second Address | University Place, WA 98466-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 17/09/2014 |