Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 12079 | ND |
Y | 208000000X | Pediatrician | 7293442-1205 | UT |
N | 208000000X | Pediatrician | A111138 | CA |
N | 208000000X | Pediatrician | M4143 | TX |
NPI | 1013077478 |
---|---|
Provider Name | Amber Sharp Heise |
First Address | Taylorsville, UT 84129-2822 |
Second Address | Taylorsville, UT 84129-2822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 20/05/2014 |