Provider Demographics
NPI:1225021934
Name:MARBUT, KRISTIE K (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:K
Last Name:MARBUT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3698 REDMAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1521
Mailing Address - Country:US
Mailing Address - Phone:801-906-0513
Mailing Address - Fax:801-906-0516
Practice Address - Street 1:4113 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE F
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:253-565-7686
Practice Address - Fax:253-566-0210
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50963944405363LN0005X
WAAP30004331363LP0200X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics