Provider Demographics
NPI:1447583471
Name:KLEMETSON, LEEANN C (FNP)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:C
Last Name:KLEMETSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12433 FORT ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9363
Mailing Address - Country:US
Mailing Address - Phone:801-576-1086
Mailing Address - Fax:801-576-9796
Practice Address - Street 1:12433 FORT ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9363
Practice Address - Country:US
Practice Address - Phone:801-576-1086
Practice Address - Fax:801-576-9796
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT214637-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily