Healthcare Provider Details

I. General information

NPI: 1841579935
Provider Name (Legal Business Name): GRACIELA JEFFERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

9776 SITZMARK DR
SANDY UT
84092-3124
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-2401
  • Fax:
Mailing address:
  • Phone: 801-523-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number268699-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: