Healthcare Provider Details

I. General information

NPI: 1033995360
Provider Name (Legal Business Name): JENNIFER MELINDA URCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E 9TH AVE STE 106
SALT LAKE CITY UT
84103-3182
US

IV. Provider business mailing address

370 E 9TH AVE STE 106
SALT LAKE CITY UT
84103-3182
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-5700
  • Fax:
Mailing address:
  • Phone: 801-408-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12394362-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027141
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95088181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: