Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 9691669-1205 | UT |
N | 111NI0900X | Internist | 9691669-1205 | UT |
Y | 207RX0202X | Medical Oncology | 9691669-1205 | UT |
NPI | 1073699039 |
---|---|
Provider Name | Kathleen A Cooney |
First Address | Salt Lake City, UT 84102-1971 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 13/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2790720 | (05) | MI |
F04726 | (02) | MI |