Soutsada Nikki Konesavanh PA-C

NPI 1417108606 - Physician Assistant - 363A00000X

NPI Details
NPI 1417108606
Gender Female
Enumeration Date 10/06/2008
Last Updated 06/08/2011
Entity Type Individual
Active Over 8 years ago
Practice Location
100 MARIO CAPECCHI DR
SALT LAKE CITY UT, 84112-8924, US
Phone (801) 585-2341
Fax
Business Location
100 MARIO CAPECCHI DR
SALT LAKE CITY UT, 84112-8924, US
Phone
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Utah
License Number 7138480-1206
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According to our database, Soutsada Nikki Konesavanh PA-C NPI is 1417108606, taxonomy code is 363A00000X and license number is 7138480-1206, license state is located at Utah. Soutsada Nikki Konesavanh PA-C physically located at 100 Mario Capecchi Dr, Salt Lake City UT, 84112-8924. NPI Number Soutsada Nikki Konesavanh PA-C has the Individual type.

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1417108606 NPI number is provided on an as is basis without warranty of any kind. 1417108606 is maintained by the National Plan & Provider Enumeration System. The contents of Soutsada Nikki Konesavanh PA-C are for informational purposes only.