Provider Demographics
NPI:1336577964
Name:SACKS, KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SACKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W 400 N
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1916
Mailing Address - Country:US
Mailing Address - Phone:801-714-3349
Mailing Address - Fax:
Practice Address - Street 1:527 W 400 N
Practice Address - Street 2:SUITE 3
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1916
Practice Address - Country:US
Practice Address - Phone:801-714-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT198051-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse