Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 202463-4405 | UT |
NPI | 1033383328 |
---|---|
Provider Name | Ms. Annette Smith Harman |
First Address | Slc, UT 84158-1289 |
Second Address | Slc, UT 84113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202463-4405 | STATE LICENSE (01) | UT |