Provider Demographics
NPI:1578763389
Name:KINIKINI, SUSANA AUHANGAMEA (C-FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:AUHANGAMEA
Last Name:KINIKINI
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:MS
Other - First Name:SUSANA
Other - Middle Name:AUHANGAMEA
Other - Last Name:KINIKINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:C-FNP
Mailing Address - Street 1:FAIRFAX @ VIRGINIA STREET
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103
Mailing Address - Country:US
Mailing Address - Phone:801-536-3517
Mailing Address - Fax:801-536-3549
Practice Address - Street 1:FAIRFAX @ VIRGINIA STREET
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103
Practice Address - Country:US
Practice Address - Phone:801-536-3517
Practice Address - Fax:801-536-3549
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT219823-4405 / 8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily