Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 278825-4405 | UT |
NPI | 1013001247 |
---|---|
Provider Name | Peggy Anne Jerome |
First Address | Sandy, UT 84094-0798 |
Second Address | West Jordan, UT 84088-9311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 14/12/2016 |