Provider Demographics
NPI:1265400568
Name:KAPSA, CHRISTINE W (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:W
Last Name:KAPSA
Suffix:
Gender:F
Credentials:NP
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 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1501
Mailing Address - Country:US
Mailing Address - Phone:801-521-2640
Mailing Address - Fax:801-363-6407
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-521-2640
Practice Address - Fax:801-363-6407
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT981964744405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP22048Medicare UPIN