Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 11673A | WY |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 9373044-1205 | UT |
NPI | 1174802250 |
---|---|
Provider Name | Dr. Lauren H Theilen |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 17/12/2021 |