MEDICARE: JENNIFER COLTRIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1841997418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER COLTRIN

Provider Business Mailing Address
First Line	:	1649 W ANTELOPE DR STE B20
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1193
Country	:	US
Telephone Number	:	385-501-0055
Fax Number	:	801-692-6655

Provider Business Practice Location Address
First Line	:	1649 W ANTELOPE DR STE B20
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1193
Country	:	US
Telephone Number	:	385-501-0055
Fax Number	:	801-692-6655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	02/14/2023

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Directions to “ JENNIFER COLTRIN ” Practice Location

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