Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5940780-9922 | UT |
NPI | 1013001718 |
---|---|
Provider Name | Noelle L Wilhelmsen |
First Address | Provo, UT 84601 |
Second Address | Provo, UT 84601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870515716 | DENTAL SELECT (01) | UT |