Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 12218075-1205 | UT |
NPI | 1366804684 |
---|---|
Provider Name | Kimberly L. Stevenson |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 23/11/2021 |