Provider Demographics
NPI:1700585874
Name:EARL, EMMA ROSE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:EARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ROSE
Other - Last Name:DIOSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:470 E HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2828
Mailing Address - Country:US
Mailing Address - Phone:406-945-2821
Mailing Address - Fax:
Practice Address - Street 1:27 S MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5888
Practice Address - Country:US
Practice Address - Phone:801-581-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program