Individual
LESLIE DIVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
589 S STATE ST, PROVO, UT 84606-5056
(801) 429-2000
Mailing address
589 SOUTH STATE STREET, PROVO, UT 84606
(801) 429-2000
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
5611104-4402
UT
Other
Enumeration date
03/04/2016
Last updated
04/15/2020
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