Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DR.0060605 | CO |
N | 111NI0900X | Internist | DR.0060605 | CO |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 112465191205 | UT |
NPI | 1023437696 |
---|---|
Provider Name | Kelsey Desalvo |
First Address | Salt Lake City, UT 84102-2310 |
Second Address | Salt Lake City, UT 84102-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 07/08/2019 |