Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 9428425-3400 | UT |
NPI | 1083931273 |
---|---|
Provider Name | Laura R O'bryan |
First Address | Murray, UT 84107-6208 |
Second Address | Murray, UT 84107-6208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 13/05/2016 |