Individual
KIMBERLY RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5965 S 900 E, SALT LAKE CITY, UT 84121-1720
(801) 263-7138
Mailing address
5965 S 900 E, SALT LAKE CITY, UT 84121-1720
(801) 263-7138
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
8202176-3102
UT
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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