Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 5150808-1205 | UT |
NPI | 1083793558 |
---|---|
Provider Name | Marie F. Couldwell |
First Address | Salt Lake City, UT 84158-1100 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 17/12/2021 |