Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 173454-1205 | UT |
NPI | 1013920677 |
---|---|
Provider Name | Patricia Bearnson |
First Address | Salt Lake City, UT 84124-2469 |
Second Address | Salt Lake City, UT 84124-2469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 12/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E27804 | (02) |