Individual
HOLLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2040 MURRAY HOLLADAY RD STE 205, SALT LAKE CITY, UT 84117-5197
(801) 274-0299
Mailing address
2422 COBBLESTONE WAY, SANDY, UT 84093-1884
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
6683403-3101
UT
Other
Enumeration date
02/11/2008
Last updated
02/11/2008
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