SOUTSADA NIKKI KONESAVANH

SALT LAKE CITY, UT
NPI1417108606
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: UT  7138480-1206)
Additional Taxonomies363A00000X Physician Assistant
(Licence: UT  7138480-1206)
Enumeration Date2008-10-06
Last Update Date2021-11-17
Business Address
SOUTSADA NIKKI KONESAVANH PA-C
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84112-8924
Phone number: 801-585-2341
Mailing Address
SOUTSADA NIKKI KONESAVANH PA-C
100 MARIO CAPECCHI DR
SALT LAKE CITY, UT 84112-8924
Phone number: