Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 290211-4405 | UT |
NPI | 1043495807 |
---|---|
Provider Name | Jennifer Hulick Bautista |
First Address | Sandy, UT 84094-1208 |
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 | 28/12/2007 |
Last Update Date | 28/12/2007 |