Individual
CARLY LYNNE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1033 W 450 S, SPANISH FORK, UT 84660-5612
(801) 471-9201
Mailing address
1033 W 450 S, SPANISH FORK, UT 84660-5612
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
369185-4405
UT
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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