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General NPI Number Information
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NPI Number | 1942997382
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Entity Type | Individual
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Provider Name | JONAS JEN TWU
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Gender | Male
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 6084 S SUMMIT VISTA BLVD
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-3209
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Country | US
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Telephone | 385-255-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 138 E 12300 S STE C200
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City | DRAPER
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State | UT
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Zip | 84020-7976
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10392833-4405
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License Number State | UT
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