Individual
SARA LAUREN CICMANEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
389 S 900 E, INTERMOUNTAIN SALT LAKE CLINIC, SALT LAKE CITY, UT 84102-2310
(385) 282-2650
Mailing address
389 S 900 E, SALT LAKE CITY, UT 84102-2310
(385) 282-2650
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
8137257-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2010
Last updated
07/15/2014
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