Provider Demographics
NPI:1023018017
Name:KLEIN, MARILYN JEAN (FNPC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4901
Mailing Address - Country:US
Mailing Address - Phone:435-649-2989
Mailing Address - Fax:
Practice Address - Street 1:1670 BONANZA DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7205
Practice Address - Country:US
Practice Address - Phone:435-649-5989
Practice Address - Fax:435-649-5991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT2229454405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily