Provider Demographics
NPI:1457517369
Name:MEIDINGER, GLADYS KAYE
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:KAYE
Last Name:MEIDINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:
Other - Last Name:MEIDINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:6360 S 3000 E STE 300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6926
Mailing Address - Country:US
Mailing Address - Phone:801-944-3195
Mailing Address - Fax:801-944-3190
Practice Address - Street 1:6360 S 3000 E STE 310
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6939
Practice Address - Country:US
Practice Address - Phone:801-944-3144
Practice Address - Fax:801-944-3186
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355572-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily