Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5069 | NE |
Y | 208000000X | Pediatrician | 66196611205 | UT |
NPI | 1003029935 |
---|---|
Provider Name | Dr. Monica Child Wonnacott |
First Address | Riverton, UT 84096-7012 |
Second Address | Riverton, UT 84096-7012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 13/05/2013 |