Individual
MCKENNA KELLY VANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, APRN
Contact information
Practice address
4401 HARRISON BLVD, OGDEN, UT 84403-3195
(801) 387-4300
Mailing address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4100
(801) 662-4285
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
9428379-3102
UT
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
9428379-4405
UT
Other
Enumeration date
04/22/2020
Last updated
02/11/2022
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