| NPI | 1992324206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA LYNN BROADHEAD Dnp 801-654-3229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2020-11-04 |