| NPI | 1083438626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN PAYNE Director 801-815-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2024-11-11 |