Provider Demographics
NPI:1144416983
Name:WIRTHLIN, KIRA
Entity Type:Individual
Prefix:MRS
First Name:KIRA
Middle Name:
Last Name:WIRTHLIN
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 1:325 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3103
Mailing Address - Country:US
Mailing Address - Phone:435-749-0707
Mailing Address - Fax:
Practice Address - Street 1:325 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3103
Practice Address - Country:US
Practice Address - Phone:435-749-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker