Provider Demographics
NPI:1487744082
Name:GITLIN, DENISE (APRN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GITLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E 3900 S
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1228
Mailing Address - Country:US
Mailing Address - Phone:801-743-4730
Mailing Address - Fax:801-743-4736
Practice Address - Street 1:1140 E 3900 S
Practice Address - Street 2:SUITE 340
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1228
Practice Address - Country:US
Practice Address - Phone:801-743-4730
Practice Address - Fax:801-743-4736
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200041-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00474000OtherRR MEDICARE
WY1053593921Medicaid
UT000062729Medicare PIN
UTP00474000OtherRR MEDICARE