Healthcare Provider Details

I. General information

NPI: 1205974763
Provider Name (Legal Business Name): JILLENE LOUISE ASKERLULND SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 450 S
SANTAQUIN UT
84655-8062
US

IV. Provider business mailing address

PO BOX 445
SANTAQUIN UT
84655-0445
US

V. Phone/Fax

Practice location:
  • Phone: 801-472-8715
  • Fax: 801-754-3677
Mailing address:
  • Phone: 801-472-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number02-231
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: