Provider Demographics
NPI:1659397545
Name:KENDALL, DIANE M (APRN, BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:KENDALL
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9720 S 1300 E
Mailing Address - Street 2:STE 240
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3712
Mailing Address - Country:US
Mailing Address - Phone:801-501-2025
Mailing Address - Fax:801-501-4099
Practice Address - Street 1:9720 S 1300 E
Practice Address - Street 2:STE 240
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3712
Practice Address - Country:US
Practice Address - Phone:801-501-2025
Practice Address - Fax:801-501-4099
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT212106-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP44678Medicare UPIN