Healthcare Provider Details

I. General information

NPI: 1912249293
Provider Name (Legal Business Name): CRISTEN JENKINS WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11643 S HILL STONE DR
SOUTH JORDAN UT
84095-8083
US

IV. Provider business mailing address

11643 S HILL STONE DR
SOUTH JORDAN UT
84095-8083
US

V. Phone/Fax

Practice location:
  • Phone: 801-819-5566
  • Fax:
Mailing address:
  • Phone: 801-819-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number6364187-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: