Healthcare Provider Details

I. General information

NPI: 1508216581
Provider Name (Legal Business Name): JESSE JEN TWU DNP NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 02/27/2024
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S 500 E
SALT LAKE CITY UT
84102-1907
US

IV. Provider business mailing address

138 E 12300 S STE C200
DRAPER UT
84020-7976
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-1485
  • Fax:
Mailing address:
  • Phone: 385-215-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7672382-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7672382-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: