Provider Demographics
NPI:1851626980
Name:KATHLEEN RODMAN FNP, INC.
Entity Type:Organization
Organization Name:KATHLEEN RODMAN FNP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-583-9639
Mailing Address - Street 1:255 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2610
Mailing Address - Country:US
Mailing Address - Phone:801-583-9639
Mailing Address - Fax:801-583-9639
Practice Address - Street 1:255 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2610
Practice Address - Country:US
Practice Address - Phone:801-583-9639
Practice Address - Fax:801-583-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT193462-4405251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care