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General NPI Number Information
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NPI Number | 1508984162
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Entity Type | Individual
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Provider Name | JENNIFER ANN DECOU M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | UNIVERSITY HOSPITAL DEPT OF ANESTHESIOLOGY 30 N 1900 E, ROOM 3C444
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone | 801-205-4116
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Fax |
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Provider Business Mailing Address
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Address Line | 1217 N 2525 W
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City | LAYTON
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State | UT
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Zip | 84041-7717
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Country | US
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Telephone | 801-593-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5767787-1205
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License Number State | UT
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