Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 5228084-1205 | UT |
NPI | 1558466177 |
---|---|
Provider Name | Patricia A Vitale |
First Address | Murray, UT 84107-7282 |
Second Address | Murray, UT 84107-7282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 23/11/2021 |