Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 191307-4405 | UT |
NPI | 1194021568 |
---|---|
Provider Name | Constance E Valentine |
First Address | Salt Lake City, UT 84132-0001 |
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 | 02/02/2011 |
Last Update Date | 02/02/2011 |