| NPI | 1770070260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE PENDERGRASS President 435-637-0313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: UT 3196374405) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-19 |