Individual
MRS. TERA LUANE JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2557 LINCOLN AVE, OGDEN, UT 84401-1307
(801) 622-5272
Mailing address
2557 LINCOLN AVE, OGDEN, UT 84401-1307
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
119097543101
UT
Other
Enumeration date
06/28/2021
Last updated
06/28/2021
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