Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 12404270-1205 | UT |
Y | 111NI0900X | Internist | 12404270-1205 | UT |
NPI | 1003444803 |
---|---|
Provider Name | Therese J. Battiola |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2020 |
Last Update Date | 16/09/2021 |