Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 11049874-3400 | UT |
NPI | 1073082269 |
---|---|
Provider Name | Christine E Larson |
First Address | Salt Lake City, UT 84103-3850 |
Second Address | Salt Lake City, UT 84103-3850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2018 |
Last Update Date | 16/11/2018 |