Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 51301564405 | UT |
NPI | 1053325720 |
---|---|
Provider Name | Amanda Lee Jones |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Orem, UT 84057-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 16/10/2007 |