Healthcare Provider Details

I. General information

NPI: 1629414826
Provider Name (Legal Business Name): JENNIFER MICHELLE CAYABYAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MICHELLE WUERSTLIN

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S FASHION BLVD
MURRAY UT
84107-6157
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4100
  • Fax:
Mailing address:
  • Phone: 423-280-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN17620
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9750862-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: