Individual
JACIE ANNA MUNDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8TH AVE C ST E 80, SALT LAKE CITY, UT 84143-0001
(801) 408-1100
Mailing address
6008 37TH AVE NE, RUGBY, ND 58368-8760
(701) 771-0134
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11609094-1206
UT
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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