Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 5925695-4405 | UT |
NPI | 1043626245 |
---|---|
Provider Name | Ms. Kristen Gardner |
First Address | Murray, UT 84157-1117 |
Second Address | Murray, UT 84107-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 22/08/2014 |