Provider Demographics
NPI:1578763389
Name:KINIKINI, SUSANA AUHANGAMEA (C-FNP, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:AUHANGAMEA
Last Name:KINIKINI
Suffix:
Gender:F
Credentials:C-FNP, PMHNP-BC
Other - Prefix:MS
Other - First Name:SUSANA
Other - Middle Name:AUHANGAMEA
Other - Last Name:KINIKINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:C-FNP, PMHNP-BC
Mailing Address - Street 1:678 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5546
Mailing Address - Country:US
Mailing Address - Phone:016-181-2138
Mailing Address - Fax:801-507-0360
Practice Address - Street 1:5121 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT219823-4405 / 8900363LF0000X
UT219823-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily