Provider Demographics
NPI:1003029935
Name:WONNACOTT, MONICA CHILD (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:CHILD
Last Name:WONNACOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12391 S 4000 W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7012
Mailing Address - Country:US
Mailing Address - Phone:801-302-1700
Mailing Address - Fax:801-302-1714
Practice Address - Street 1:12391 S 4000 W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7012
Practice Address - Country:US
Practice Address - Phone:801-302-1700
Practice Address - Fax:801-302-1714
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5069208000000X
UT66196611205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics