| NPI | 1699105338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA SOUTHWICK Owner 801-943-3373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 200020-4405) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2014-02-19 |