Basic Information
| Provider Information | |||||||||
| NPI: | 1548510431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINIKINI | ||||||||
| FirstName: | LIANA | ||||||||
| MiddleName: | OLIVIA | ||||||||
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| Credential: | DNP, APRN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3895 W 7800 S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840885617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012807774 | ||||||||
| FaxNumber: | 8017482790 | ||||||||
| Practice Location | |||||||||
| Address1: | 3895 W 7800 S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840885617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012807774 | ||||||||
| FaxNumber: | 8017482790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4777852-4405 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | 4777852-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.