Individual
KANSAS WHITEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7295 S 2050 E, SOUTH WEBER, UT 84405-7737
(801) 979-4638
(801) 605-8549
Mailing address
7295 S 2050 E, SOUTH WEBER, UT 84405-7737
(801) 979-4638
(801) 605-8549
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
9578235-1714
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
620254000
DEPARTMENT OF LABOR
—
Enumeration date
07/31/2018
Last updated
07/31/2018
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