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1104861079
JACQUELINE BERNADINE PETRAVAGE
SALT LAKE CITY, UT
NPI
1104861079
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: UT 1664161205)
Enumeration Date
2006-06-17
Last Update Date
2007-07-08
Business Address
Dr. JACQUELINE BERNADINE PETRAVAGE M.D.
VETERAN'S HOSPITAL, 500 FOOTHILL BLVD BLDG 47
SALT LAKE CITY, UT 84148-0001
Phone number: 801-582-1565
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Mailing Address
Dr. JACQUELINE BERNADINE PETRAVAGE M.D.
500 FOOTHILL BLVD
SALT LAKE CITY, UT 84148-0001
Phone number: 801-582-1565
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