Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 214973-4405 | UT |
NPI | 1376776963 |
---|---|
Provider Name | Eileen Shaw Lopes |
First Address | Orem, UT 84097-6689 |
Second Address | Slc, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2009 |
Last Update Date | 28/08/2009 |