Healthcare Provider Details

I. General information

NPI: 1225652290
Provider Name (Legal Business Name): ANGELA M JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 4500 S STE 200
SALT LAKE CITY UT
84107-8509
US

IV. Provider business mailing address

348 E 4500 S STE 200
SALT LAKE CITY UT
84107-8509
US

V. Phone/Fax

Practice location:
  • Phone: 385-257-6284
  • Fax: 801-281-9681
Mailing address:
  • Phone: 385-257-6284
  • Fax: 801-281-9681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number8013985-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: