Provider Demographics
NPI:1881884252
Name:TOLEDO, KATIE ANN
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1053 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2060
Mailing Address - Country:US
Mailing Address - Phone:801-359-3995
Mailing Address - Fax:801-359-8489
Practice Address - Street 1:1053 E 2100 S
Practice Address - Street 2:SUITE 4
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2060
Practice Address - Country:US
Practice Address - Phone:801-359-3995
Practice Address - Fax:801-359-8489
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVTAPN700363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner