Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 12113187-4405 | UT |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 12113187-4405 | UT |
NPI | 1508531856 |
---|---|
Provider Name | Ella Thompson |
First Address | Salt Lake City, UT 84106-1013 |
Second Address | Salt Lake City, UT 84108-1287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 17/12/2021 |