Healthcare Provider Details

I. General information

NPI: 1326314022
Provider Name (Legal Business Name): CHRISTINA LYNN THUET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11724 S STATE ST
DRAPER UT
84020-7163
US

IV. Provider business mailing address

7181 S CAMPUS VIEW DR STE 200
WEST JORDAN UT
84084-4312
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-2000
  • Fax:
Mailing address:
  • Phone: 801-965-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11544694-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: