Provider Demographics
NPI:1336323336
Name:KARLSEN, KRISTINE ANTONELLI (PHD, APRN)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:ANTONELLI
Last Name:KARLSEN
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MEDICAL DR
Mailing Address - Street 2:NICU
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:435-731-0091
Mailing Address - Fax:
Practice Address - Street 1:9033 FLINT WAY
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5851
Practice Address - Country:US
Practice Address - Phone:435-731-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215065-4405363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care