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NPI Code Detail

MEDICARE: JORDYN DAUGHERTY

MEDICARE:   JORDYN  DAUGHERTY
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
1247000000XHealth Information Technician

General Provider Information

NPI Number : 1275823403
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYN DAUGHERTY
Provider Business Mailing Address
First Line : 1079 PUEBLO ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84104-3232
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 150 E 700 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-3806
Country : US
Telephone Number : 801-364-8080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2011
Last Update Date : 04/08/2011

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Directions to “ JORDYN DAUGHERTY ” Practice Location

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