Individual
MIKKA MICHELE PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
1950 CIRCLE OF HOPE DR, SALT LAKE CITY, UT 84112-5500
(801) 581-2436
Mailing address
461 S 400 E, AMERICAN FORK, UT 84003-2515
(801) 901-7688
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
86680593102
UT
Other
Enumeration date
06/02/2021
Last updated
11/11/2021
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