Provider Demographics
NPI:1073027884
Name:SANDROCK, KIM DAWN (RN)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:DAWN
Last Name:SANDROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7906 S 965 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0218
Mailing Address - Country:US
Mailing Address - Phone:385-214-9759
Mailing Address - Fax:
Practice Address - Street 1:7906 S 965 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-0218
Practice Address - Country:US
Practice Address - Phone:385-214-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4926588-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health