Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 7469956-1205 | UT |
N | 2080P0204X | Pediatric Emergency Doctor | 7469956-1205 | UT |
NPI | 1093969495 |
---|---|
Provider Name | Danielle Elise Smith |
First Address | Vineyard, UT 84059-2903 |
Second Address | Provo, UT 84604-3380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 05/01/2022 |