Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 283578-4405 | UT |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 283578-4405 | UT |
NPI | 1023412434 |
---|---|
Provider Name | Gaylinn Breeze |
First Address | West Jordan, UT 84084-2963 |
Second Address | West Jordan, UT 84084-2963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2014 |
Last Update Date | 14/10/2014 |