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Individual

AMBER SHARP HEISE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4745 S 3200 W, TAYLORSVILLE, UT 84129-2822
(801) 964-6124
Mailing address
4745 S 3200 W, TAYLORSVILLE, UT 84129-2822
(801) 964-6124

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
12079
ND
208000000X
Pediatrics Physician
Primary
7293442-1205
UT
208000000X
Pediatrics Physician
A111138
CA
208000000X
Pediatrics Physician
M4143
TX

Other

Enumeration date
12/08/2006
Last updated
05/20/2014
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