Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 8205504-1205 | UT |
Y | 2080P0216X | Pediatric Rheumatologist | 8205504-1205 | UT |
NPI | 1902163553 |
---|---|
Provider Name | Sara Michelle Stern |
First Address | Salt Lake City, UT 84141-3021 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 22/11/2021 |