Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4796206-1205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4796206-1205 | UT |
NPI | 1508861477 |
---|---|
Provider Name | Bretton Heather Newman |
First Address | Salt Lake City, UT 84105-2802 |
Second Address | Salt Lake City, UT 84105-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 15/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H52969 | (02) | UT |