Individual
DR. JACQUELINE BERNADINE PETRAVAGE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
VETERAN'S HOSPITAL, 500 FOOTHILL BLVD, BLDG 47, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2544
Mailing address
500 FOOTHILL BLVD, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
(801) 584-2544
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
1664161205
UT
Other
Enumeration date
06/17/2006
Last updated
07/08/2007
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