Healthcare Provider Details

I. General information

NPI: 1821280280
Provider Name (Legal Business Name): MRS. LOUISE BELNAP JORGENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 E PAGES LN #A
CENTERVILLE UT
84014-2216
US

IV. Provider business mailing address

1126 SUNSET DR
KAYSVILLE UT
84037-9683
US

V. Phone/Fax

Practice location:
  • Phone: 801-294-0578
  • Fax: 801-298-2147
Mailing address:
  • Phone: 801-546-0825
  • Fax: 801-546-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7084541-2504
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: