Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 7992941-4405 | UT |
NPI | 1093239428 |
---|---|
Provider Name | Molly Walker Beck |
First Address | Salt Lake City, UT 84108-3023 |
Second Address | Salt Lake City, UT 84108-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 21/10/2021 |