Most Relevant Information
Provider Data
| NPI Number: | 1003473133 |
| Provider Name: | KYLIE GEORGIA NINOW |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/23/2019 |
| Last Updated: | 05/23/2019 |
Provider Practice Location
857 E 200 S
SALT LAKE CITY
UT
841022317
Practice Location Phone/Fax
| Phone: | 8014873276 |
| Fax: |
Provider Mailing Location
857 E 200 S
SALT LAKE CITY
UT
841022317
Provider Mailing Phone/Fax
| Phone: | 8014873276 |
| Fax: |