| NPI | 1881627016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELL I MADONNA Director Of Contracting And Pe 801-587-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2009-04-14 |