Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 10102332-1205 | UT |
NPI | 1003366766 |
---|---|
Provider Name | Anastasiya Mankouski |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Salt Lake City, UT 84107-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2016 |
Last Update Date | 20/11/2021 |