Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
220489-3102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U002
DESERET MUTUAL
UT
01
—
U006
INTERMOUTAIN HEALTH CARE
UT
Enumeration date
—
Last updated
—
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