Healthcare Provider Details

I. General information

NPI: 1417657545
Provider Name (Legal Business Name): JAMIE MAE BACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE MAE WALGREN

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N CENTER ST
DELTA UT
84624-8430
US

IV. Provider business mailing address

152 N 400 W
EPHRAIM UT
84627-5549
US

V. Phone/Fax

Practice location:
  • Phone: 435-864-3073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: