Provider Demographics
NPI:1033970322
Name:DORMERA, KARTY
Entity Type:Individual
Prefix:
First Name:KARTY
Middle Name:
Last Name:DORMERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S 1100 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5831
Mailing Address - Country:US
Mailing Address - Phone:801-623-2909
Mailing Address - Fax:
Practice Address - Street 1:3895 W 7800 S STE 100
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5616
Practice Address - Country:US
Practice Address - Phone:801-280-7774
Practice Address - Fax:801-748-2790
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76349974405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care