Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 5935921-4402 | UT |
NPI | 1063677276 |
---|---|
Provider Name | Sarah Jean Kidde |
First Address | Salt Lake City, UT 84105-1602 |
Second Address | Salt Lake City, UT 84112-5880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 06/12/2017 |