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General NPI Number Information
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NPI Number | 1225854573
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Entity Type | Organization
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Legal Business Name | WHITE SAGE WELLNESS, INC.
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 521 W CENTER ST
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2215
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Country | US
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Telephone | 801-234-9428
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Fax | 801-899-2459
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Provider Business Mailing Address
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Address Line | 521 W CENTER ST
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2215
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Country | US
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Telephone | 801-234-9428
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Fax | 801-899-2459
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JACQUELYNNE JORDAN
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Credential | RN
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Telephone | 801-234-9428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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