Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 2673071205 | UT |
NPI | 1265487300 |
---|---|
Provider Name | Dr. Jan B Bernhisel-Broadbent |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Salt Lake City, UT 84105-3208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 03/12/2014 |