Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53463531205 | UT |
Y | 2080P0208X | Pediatric Infectious Diseases | 5346353-1205 | UT |
NPI | 1477660405 |
---|---|
Provider Name | Marilyn E. Valentine |
First Address | Salt Lake City, UT 84108-1287 |
Second Address | Salt Lake City, UT 84108-1287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 05/06/2020 |