Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 7853107-4405 | UT |
NPI | 1053897116 |
---|---|
Provider Name | Amber N Lovell |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Murray, UT 84107-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 25/03/2019 |