Provider Demographics
NPI:1396851705
Name:MENNING, KARA L (APRN)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:L
Last Name:MENNING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 9TH AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2877
Mailing Address - Country:US
Mailing Address - Phone:801-408-5700
Mailing Address - Fax:801-408-5704
Practice Address - Street 1:370 9TH AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2877
Practice Address - Country:US
Practice Address - Phone:801-408-5700
Practice Address - Fax:801-408-5704
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4809382-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005513301Medicare ID - Type UnspecifiedMEDICARE NUMBER