Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 263084-NP6148 | CA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 330051-4405 | UT |
NPI | 1043495765 |
---|---|
Provider Name | Janet Ellen Craig |
First Address | Salt Lake City, UT 84105-2803 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2007 |
Last Update Date | 31/08/2011 |