Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 325859-2501 | UT |
NPI | 1053342402 |
---|---|
Provider Name | Janet Madsen |
First Address | Salt Lake City, UT 84148-0001 |
Second Address | Salt Lake City, UT 84148-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |