Individual
SAMANTHA HUBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(631) 278-3771
Mailing address
1862 E KALINA WAY # 11-308, SANDY, UT 84092-1244
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
11526659-4405
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2024
Last updated
05/24/2024
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