Healthcare Provider Details

I. General information

NPI: 1306571062
Provider Name (Legal Business Name): SAMANTHA ROSE YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 E 2100 S
SALT LAKE CITY UT
84115-2237
US

IV. Provider business mailing address

449 E 2100 S
SALT LAKE CITY UT
84115-2237
US

V. Phone/Fax

Practice location:
  • Phone: 801-596-2111
  • Fax:
Mailing address:
  • Phone: 801-596-2111
  • Fax: 801-359-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number12817124-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: