Provider Demographics
NPI:1922593722
Name:KRUISMAN, AUBREY ANN
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:ANN
Last Name:KRUISMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:
Other - Last Name:BOLINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:954 N 620 E
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9825
Mailing Address - Country:US
Mailing Address - Phone:435-224-4288
Mailing Address - Fax:
Practice Address - Street 1:434 W ASCENSION WAY STE 225
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-2790
Practice Address - Country:US
Practice Address - Phone:801-716-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6991194-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily