MEDICARE: WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	199354-4405	UT

General Provider Information

NPI Number	:	1174959431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CENTER

Provider Business Mailing Address
First Line	:	8178 GORGOZA PINES RD
Second Line	:	SUITE H
City	:	PARK CITY
State	:	UT
Zip	:	84098-4607
Country	:	US
Telephone Number	:	435-604-0259
Fax Number	:	435-604-0260

Provider Business Practice Location Address
First Line	:	8178 GORGOZA PINES RD
Second Line	:	SUITE H
City	:	PARK CITY
State	:	UT
Zip	:	84098-4607
Country	:	US
Telephone Number	:	435-604-0259
Fax Number	:	435-604-0260

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET A JAHRIES
Credential	:	APRN
Telephone Number	:	435-604-0259

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	03/09/2015

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Directions to “WELLNESS CENTER ” Practice Location

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