Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 9317686-2801 | UT |
NPI | 1003321837 |
---|---|
Provider Name | Dr. Carrie Anderson |
First Address | Salt Lake City, UT 84106-2142 |
Second Address | Salt Lake City, UT 84106-2142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2017 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9317686-2801 | VETERINARIAN (01) | UT |