| NPI | 1184042236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB TIPPETTS Administrator 801-820-6585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: UT 1851542872) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2014-04-04 |