Individual
MS. CAROL MANNING WHITESIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1575 S STATE ST, SALT LAKE CITY, UT 84115-1610
(801) 957-3323
Mailing address
89 WHITESIDES ST, LAYTON, UT 84041-4337
(801) 721-9914
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
197834-8900
UT
363LF0000X
Family Nurse Practitioner
1978348900
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870532738005
—
UT
Enumeration date
08/25/2008
Last updated
08/25/2008
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