1649377540 NPI number — MRS. ANGELA MARIE NICHOLSON KRULL MD

Table of content: MRS. ANGELA MARIE NICHOLSON KRULL MD (NPI 1649377540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649377540 NPI number — MRS. ANGELA MARIE NICHOLSON KRULL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRULL
Provider First Name:
ANGELA
Provider Middle Name:
MARIE NICHOLSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICHOLSON
Provider Other First Name:
ANGELA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649377540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10011 CENTENNIAL PKWY
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-4156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-676-7627
Provider Business Mailing Address Fax Number:
801-676-7630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10011 CENTENNIAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84070-4156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-676-7627
Provider Business Practice Location Address Fax Number:
801-676-7630
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  61429451205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1316160534 . This is a "GROUP NPI" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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