| Doctor Name: | MARLEE GOMM DICRISTOFANO |
| NPI Number: | 1043675994 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BSN, RN |
| License Number: | 4826371-3102 |
| Business Practice Address: | 917 E 1150 N Pleasant Grove, UT - 840629100 |
| Business Phone Number: | 8013686723 |
| Business Fax Number: | |
| Mailing Address: | 917 E 1150 N, PLEASANT GROVE |
| State: | UT |
| Postal Code: | 840629100 |
| Phone Number: | 8013686723 |
| Fax Number: | |
| NPI Enumeration Date: | 12/19/2015 |
| NPI Last Update Date: | 12/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WL0100X |
| License Number: | 4826371-3102 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Lactation Consultant |
| Taxonomy Definition: | |