Organization
KELLY WOSNIK INC
Active
Other names
Bristol Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY WOSNIK NP-C (MEDICAL DIRECTOR)
(801) 903-5903
Entity
Organization
Contact information
Practice address
1125 W CENTER ST, OREM, UT 84057-5207
(801) 903-5903
(801) 515-0935
Mailing address
935 S OREM BLVD, OREM, UT 84058-5011
(801) 903-5903
(801) 515-0935
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
327710-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010479
—
UT
Enumeration date
03/21/2011
Last updated
11/02/2020
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