Organization
COTTONWOOD MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN LAPOLLA APRN (OWNER)
(801) 281-5775
Entity
Organization
Contact information
Practice address
8822 S REDWOOD RD STE 103, WEST JORDAN, UT 84088-9341
(801) 281-5775
(801) 823-0213
Mailing address
8414 S KINGS COVE DR, SALT LAKE CITY, UT 84121-6064
(801) 231-4932
(866) 936-0188
Taxonomy
Speciality
Code
Description
License number
State
364SA2100X
Acute Care Clinical Nurse Specialist
Primary
2121144405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2121144405
STATE LICENSE
UT
Enumeration date
01/21/2015
Last updated
11/14/2024
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