Provider Demographics
NPI:1619103751
Name:SPEED, GINETTE I (FNP)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:I
Last Name:SPEED
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 1:1060 E 100 S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1501
Mailing Address - Country:US
Mailing Address - Phone:801-531-9453
Mailing Address - Fax:801-531-9467
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-531-9453
Practice Address - Fax:801-531-9467
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT197949-8905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily