Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 175785-1202 | UT |
NPI | 1487806998 |
---|---|
Provider Name | Steve Wayne Elmore |
First Address | Sandy, UT 84070-5164 |
Second Address | Sandy, UT 84070-5164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 15/10/2008 |