Individual
MR. GARRY WELLISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
441 S REDWOOD RD, SALT LAKE CITY, UT 84104-3539
(801) 973-2588
Mailing address
441 S REDWOOD RD, SALT LAKE CITY, UT 84104-3539
(801) 973-2588
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
6848307-4405
UT
Other
Enumeration date
06/17/2014
Last updated
06/17/2014
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