Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 198143-4405 | UT |
NPI | 1013155357 |
---|---|
Provider Name | Patricia Hartley-Clanton |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Murray, UT 84107-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2009 |
Last Update Date | 24/01/2009 |