Provider Demographics
NPI:1992943401
Name:MINKEVITCH, KARYN ANNE (APRN-C, MSN, FNP)
Entity type:Individual
Prefix:MS
First Name:KARYN
Middle Name:ANNE
Last Name:MINKEVITCH
Suffix:
Gender:F
Credentials:APRN-C, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3186
Mailing Address - Country:US
Mailing Address - Phone:801-387-2371
Mailing Address - Fax:801-387-4257
Practice Address - Street 1:4300 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3186
Practice Address - Country:US
Practice Address - Phone:801-387-2371
Practice Address - Fax:801-387-4257
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3080945-4405282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital