Organization
DIVISION OF NEPHROLOGY UNIVERSITY OF UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELL I MADONNA (DIRECTOR OF CONTRACTING AND PE)
(801) 587-6464
Entity
Organization
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
PO BOX 413033, SALT LAKE CITY, UT 84141-0001
(801) 213-3800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RN0300X
Nephrology Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100502046
—
NV
05
—
45884269
—
NM
05
—
807289100
—
ID
05
—
807289100
—
NV
05
—
876000525382
—
UT
Enumeration date
07/09/2006
Last updated
04/14/2009
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