Individual
MS. KIMBER TRACY VAN WAGONER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
B.A., R.N.
Contact information
Practice address
1020 S MAIN ST, SALT LAKE CITY, UT 84101-3176
(801) 539-7000
(801) 539-7050
Mailing address
1134 E 2700 S, D 26, SALT LAKE CITY, UT 84106-2642
(801) 486-4104
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
03081433102
UT
Other
Enumeration date
01/25/2006
Last updated
07/08/2007
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