Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 378889-1205 | UT |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 378889-1205 | UT |
NPI | 1043330723 |
---|---|
Provider Name | Dr. Amy Tremain Kirk |
First Address | Salt Lake City, UT 84109-3240 |
Second Address | Salt Lake City, UT 84108-1220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 21/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H39041 | (02) | UT |