Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 337979-4408 | UT |
NPI | 1366964140 |
---|---|
Provider Name | Kimberlee Brooks Chenoweth |
First Address | Sandy, UT 84094-6908 |
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 | 12/07/2017 |
Last Update Date | 14/06/2019 |