Individual
IANETA MISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
344 E 100 S, SUITE 301, SALT LAKE CITY, UT 84111-1700
(801) 322-4257
Mailing address
688 MORTON DRIVE, SALT LAKE, UTAH 84116
(801) 325-1428
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/09/2016
Last updated
08/09/2016
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