Individual
KAITLIN DIANE CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1250 E 3900 S STE 260, SALT LAKE CITY, UT 84124-1371
(801) 265-2000
Mailing address
1250 E 3900 S STE 260, SALT LAKE CITY, UT 84124-1371
(801) 265-2000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10827182-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108271723102
DOPL
UT
01
—
10827182-4405
DOPL
UT
Enumeration date
06/14/2022
Last updated
08/16/2023
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