Healthcare Provider Details

I. General information

NPI: 1508984162
Provider Name (Legal Business Name): JENNIFER ANN DECOU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ANN PUSEY M.D.

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HOSPITAL DEPT OF ANESTHESIOLOGY 30 N 1900 E, ROOM 3C444
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

1217 N 2525 W
LAYTON UT
84041-7717
US

V. Phone/Fax

Practice location:
  • Phone: 801-205-4116
  • Fax:
Mailing address:
  • Phone: 801-593-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5767787-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: