Individual
KRISTEN HAAS BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3723 W 12600 S STE 360, RIVERTON, UT 84065-7296
(801) 285-4700
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 285-4700
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
5101019941
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
9732284-1204
UT
Other
Enumeration date
06/05/2012
Last updated
06/24/2016
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