Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 8272138-4405 | UT |
NPI | 1033687983 |
---|---|
Provider Name | Dr. Valerie Rebekah Birdsall |
First Address | Salt Lake City, UT 84106-2795 |
Second Address | West Valley City, UT 84119-4715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2018 |
Last Update Date | 08/11/2018 |