IndividualActive
Annie Kornetzke, DO
NPI 1053979948 · Family Medicine Physician · Taylorsville, UT
Provider details
- NPI number
- 1053979948
- Entity type
- Individual
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- License
- 125074527 (IL)
Practice location
4745 S 3200 W
Taylorsville, UT 84129-2822
Phone: (801) 964-6214
Fax: (877) 497-4661
Mailing address
2621 S 3270 W
Taylorsville, UT 84119-1119
Registry dates
- Enumerated
- 2019-06-05
- Last updated
- 2022-07-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.