Provider Demographics
NPI:1366030736
Name:CARROLL, NATASHA B
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:B
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E SOUTH TEMPLE # 1L
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84150-9002
Mailing Address - Country:US
Mailing Address - Phone:801-240-2428
Mailing Address - Fax:
Practice Address - Street 1:15 E SOUTH TEMPLE # 1L
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84150-9002
Practice Address - Country:US
Practice Address - Phone:801-240-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program