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Contact Information

MOUNTAIN WEST EAR NOSE AND THROAT LC
1551 RENAISSANCE TOWNE DR
SUITE 310
BOUNTIFUL, UT84010-7667
 Phone: 801-295-5581
 Fax: 801-295-9253
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Pediatric Otolaryngology

207YP0228X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for MOUNTAIN WEST EAR NOSE AND THROAT LC · (Female)

NPI # 1770631194
Status Active
Credentials
Entity Individual
Enumeration date 01/08/2007
Last updated 08/05/2010 - About 16 years ago
Sole proprietor 1 Not specified
Identifiers
  • UT License # 178486-1205
  • UT License # 182660-1205
  • UT License # 188579-1205
  • UT License # 264339-1205
  • WY License # 5387A
  • WY License # 5395A
  • WY Medicaid 108796700
  • WY Medicaid 124257100
  • UT Other DA4984 RAILROAD MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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