Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 7099824-1206 | UT |
NPI | 1114354834 |
---|---|
Provider Name | Mrs. Jennifer Peck Bunker |
First Address | Layton, UT 84041-0337 |
Second Address | Layton, UT 84041-8803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2013 |
Last Update Date | 04/12/2019 |