Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 1164765053 | UT |
NPI | 1164765053 |
---|---|
Provider Name | Kristin Marie Hueftle |
First Address | Salt Lake City, UT 84109-1832 |
Second Address | Salt Lake City, UT 84112-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2013 |
Last Update Date | 20/10/2021 |