Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 11763974-1205 | UT |
NPI | 1023545670 |
---|---|
Provider Name | Natalie Justine Tedford |
First Address | Salt Lake City, UT 84108-1287 |
Second Address | Salt Lake City, UT 84108-1287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 05/06/2020 |