Individual
JOHANNA SAGE SALAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MD
Contact information
Practice address
375 S CHIPETA WAY STE A, SALT LAKE CITY, UT 84108-1261
(801) 581-7914
Mailing address
375 S CHIPETA WAY STE A, SALT LAKE CITY, UT 84108-1261
(801) 581-7914
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11414333-1205
UT
207Q00000X
Family Medicine Physician
LP04109
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP04109
RHODE ISLAND LICENSE
RI
Enumeration date
06/21/2017
Last updated
09/12/2019
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