Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4891288-1204 | UT |
NPI | 1003080409 |
---|---|
Provider Name | Allison Hanna |
First Address | Bountiful, UT 84010-7717 |
Second Address | Bountiful, UT 84010-7717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 11/11/2015 |