MADELEINE RAE FORKNER (NPI# 1518431535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518431535 |
| Entity Type | Individual |
| Full Name | MADELEINE RAE FORKNER |
| Practice Address |
4444 S 700 E Ste 203 Salt Lake City UT 84107-3075 |
| Practice Telephone | 8012684887 |
| Enumeration Date | 2019-01-12 |
| Last Update Date | 2019-01-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246Z00000X | Specialist/Technologist, Other | RBT-18-72345 | UT | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
4444 S 700 E STE 203 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84107-3075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093025926 | Justin Naylor | Social Worker | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2010-10-13 |
| 1487294674 | Max Strasburger | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2020-01-15 |
| 1477193662 | Aileen Casas | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2020-01-15 |
| 1518507706 | Ryan Leister | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107 | 2020-01-15 |
| 1780224972 | Jake Beede | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2020-01-15 |
| 1881240471 | Christine Casper | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-08-10 |
| 1619522232 | Rylee Bunten | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-08-09 |
| 1295209989 | Matthew Scott Meldrum | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-01-15 |
| 1932673993 | Kaitlyn Marie Samhammer | Specialist | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-01-13 |
| 1548733686 | Emily Barfuss | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-01-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410517 | Brielle Nicole Poulter | Student in an Organized Health Care Education/Training Program | 345 East 4500 So #260, Murray, UT 84107 | 2020-09-01 |
| 1467016592 | Ashlee Brown | Social Worker | C-134, 5284 Commerce Drive, Murray, Murray, UT 84107 | 2019-04-24 |
| 1568940633 | Samantha Duff | Occupational Therapist | 5770 S Fashion Blvd, Bldg 5 Ste 201, Murray, UT 84107 | 2018-08-01 |
| 1881185247 | Derek John Sharp | Occupational Therapist | 5770 S Fashion Blvd, Bldg #5, Suite 210, Murray, UT 84107 | 2018-05-22 |
| 1093223091 | Erin Nicole Hill | Counselor | 345 East 4500 South Suite 260, Murray, UT 84107 | 2018-01-12 |
| 1588171219 | Nicole Danielle Jensen | Counselor | 345 East 4500 South, Suite 260, Murray, UT 84107 | 2018-01-03 |
| 1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
| 1043739667 | Karyn K Hodge | Audiologist | 4500 So. 777. E. Ste #110, Murray, UT 84107 | 2017-09-14 |
| 1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
| 1396261152 | Megan Lehane Delano | Plastic Surgery | 5169 Cottonwood St Ste 420, Murray, UT 84107 | 2017-08-14 |
| Find all providers in zip 84107 | ||||
| Taxonomy Code | 246Z00000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Specialist/Technologist, Other |
| General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
| 1366805020 | Adam Ward | Specialist/Technologist, Other | 455 N 400 E, Salt Lake City, UT 84103-1230 | 2016-03-31 |
| 1659669919 | Innovasis Neurological, Inc | Specialist/Technologist, Other | 614 E 3900 S, Salt Lake City, UT 84107-1902 | 2011-07-20 |
| 1487294674 | Max Strasburger | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2020-01-15 |
| 1477193662 | Aileen Casas | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2020-01-15 |
| 1518507706 | Ryan Leister | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107 | 2020-01-15 |
| 1780224972 | Jake Beede | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2020-01-15 |
| 1881240471 | Christine Casper | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-08-10 |
| 1619522232 | Rylee Bunten | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-08-09 |
| 1295209989 | Matthew Scott Meldrum | Specialist/Technologist, Other | 4444 S 700 E Ste 203, Salt Lake City, UT 84107-3075 | 2019-01-15 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.