Healthcare Provider Details

I. General information

NPI: 1972328581
Provider Name (Legal Business Name): NICOLE ERIKA JESSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 N 1200 W
LEHI UT
84043-2410
US

IV. Provider business mailing address

1867 N 1200 W
LEHI UT
84043-2410
US

V. Phone/Fax

Practice location:
  • Phone: 801-891-3143
  • Fax:
Mailing address:
  • Phone: 801-891-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11584083-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: