Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 294043-4405 | UT |
NPI | 1134304991 |
---|---|
Provider Name | Mr. Michael Shawn Ward |
First Address | Stansbury Park, UT 84074-8190 |
Second Address | Slc, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2007 |
Last Update Date | 12/08/2021 |