Individual
CHARLIE R JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1380 E MEDICAL CENTER DR, SUITE #1400, ST GEORGE, UT 84790-2123
(435) 251-2600
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 251-2600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1976944405
UT
Other
Enumeration date
07/25/2006
Last updated
06/26/2008
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