Healthcare Provider Details

I. General information

NPI: 1841970662
Provider Name (Legal Business Name): MCCALL JEWETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/25/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W SR 164
SALEM UT
84653
US

IV. Provider business mailing address

PO BOX 30079
SALT LAKE CITY UT
84130-0079
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4896
  • Fax: 801-465-0606
Mailing address:
  • Phone: 801-375-8858
  • Fax: 801-429-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8339669-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: