Healthcare Provider Details

I. General information

NPI: 1336530328
Provider Name (Legal Business Name): JESSICA PARENTEAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6562 S GRAYLINE CT
WEST JORDAN UT
84081-5525
US

IV. Provider business mailing address

6562 S GRAYLINE CT
WEST JORDAN UT
84081-5525
US

V. Phone/Fax

Practice location:
  • Phone: 385-439-2204
  • Fax:
Mailing address:
  • Phone: 385-439-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number8898997-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: