Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 220011-4402 | UT |
NPI | 1093112914 |
---|---|
Provider Name | Diana Lee |
First Address | Provo, UT 84604-3305 |
Second Address | Pleasant Grove, UT 84062-4097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2014 |
Last Update Date | 03/02/2020 |