Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 9424423-4405 | UT |
NPI | 1073139853 |
---|---|
Provider Name | Charity Bushati |
First Address | North Salt Lake, UT 84054-6029 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2020 |
Last Update Date | 05/01/2022 |