| NPI | 1366982522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE YOUNG Provider 801-815-2967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 53036184405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 5303618-4405) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-08-10 |