Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 279490-4405/APRN | UT |
N | 363LG0600X | Nurse Practitioner - Gerontology | 2794904405 | UT |
NPI | 1083852677 |
---|---|
Provider Name | Jill Stratford Waldron |
First Address | Salt Lake City, UT 84132 |
Second Address | Salt Lake City, UT 84132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 16/12/2021 |