| NPI | 1063798403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA W BAGLEY Owner 801-918-9793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 1166904405) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2011-10-31 |