JACKIE EVANS BLACK

PROVO, UT
NPI1629144308
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy163WC1500X Registered Nurse, Community Health
(Licence: UT  218040-3102)
Enumeration Date2006-11-27
Last Update Date2007-07-09
Business Address
-- JACKIE EVANS BLACK RN
151 S UNIVERSITY AVE # 1900
PROVO, UT 84601-4427
Phone number: 801-851-7026
Mailing Address
-- JACKIE EVANS BLACK RN
265 E 200 S
SALEM, UT 84653-9452
Phone number: 801-423-2373
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