Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 261015-4405 | UT |
NPI | 1477764843 |
---|---|
Provider Name | Susi C Dalanhese |
First Address | Lehi, UT 84043-2714 |
Second Address | Slc, UT 84143-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 12/10/2018 |