Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 10714522-1205 | UT |
N | 2084N0402X | Child Neurologist | 10714522-1205 | UT |
NPI | 1013451962 |
---|---|
Provider Name | Melissa Ann Wright |
First Address | Salt Lake City, UT 84113-1125 |
Second Address | Salt Lake City, UT 84113-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 07/01/2022 |