| NPI | 1225854573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYNNE JORDAN Office Manager 801-234-9428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2024-12-02 |