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1114676004
JESSICA D WISSENBACH
PROVO, UT
NPI
1114676004
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: UT 13516654-1204)
Enumeration Date
2022-03-20
Last Update Date
2024-08-01
Business Address
JESSICA D WISSENBACH DO
395 W COUGAR BLVD STE 205
PROVO, UT 84604-3328
Phone number: 801-357-1770
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Mailing Address
JESSICA D WISSENBACH DO
PO BOX 27128
SALT LAKE CITY, UT 84127-0128
Phone number:
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