Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 319843-4405 | UT |
NPI | 1063695468 |
---|---|
Provider Name | Mrs. Kristin Bryant |
First Address | Salt Lake City, UT 84108-2771 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2007 |
Last Update Date | 10/12/2007 |