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General NPI Number Information
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NPI Number | 1174959431
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTER
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 8178 GORGOZA PINES RD SUITE H
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City | PARK CITY
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State | UT
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Zip | 84098-4607
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Country | US
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Telephone | 435-604-0259
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Fax | 435-604-0260
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Provider Business Mailing Address
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Address Line | 8178 GORGOZA PINES RD SUITE H
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City | PARK CITY
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State | UT
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Zip | 84098-4607
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Country | US
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Telephone | 435-604-0259
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Fax | 435-604-0260
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET A JAHRIES
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Credential | APRN
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Telephone | 435-604-0259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 199354-4405
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License Number State | UT
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