Healthcare Provider Details

I. General information

NPI: 1942997382
Provider Name (Legal Business Name): JONAS JEN TWU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6084 S SUMMIT VISTA BLVD
TAYLORSVILLE UT
84129-3209
US

IV. Provider business mailing address

138 E 12300 S STE C200
DRAPER UT
84020-7976
US

V. Phone/Fax

Practice location:
  • Phone: 385-255-1105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10392833-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: