Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 9529156-1205 | UT |
NPI | 1003233040 |
---|---|
Provider Name | Kaitlin Carpenter |
First Address | Salt Lake City, UT 84113-1103 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 19/04/2017 |