Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 205110-4405 | UT |
NPI | 1013007608 |
---|---|
Provider Name | Donna M. Wahoff-Stice |
First Address | Salt Lake City, UT 84158-1700 |
Second Address | Salt Lake City, UT 84108-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P28431 | (02) | UT |