Healthcare Provider Details

I. General information

NPI: 1639793649
Provider Name (Legal Business Name): CHRISTOPHER JESSEN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 10/21/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10274 S AMARYLLIS DR
SANDY UT
84094-4447
US

IV. Provider business mailing address

30 N 1900 E # 4A330
SALT LAKE CITY UT
84132-4447
US

V. Phone/Fax

Practice location:
  • Phone: 801-706-6889
  • Fax:
Mailing address:
  • Phone: 801-581-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10414662-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: