Individual
JACKIE ANNE FONUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3354 W 7800 S, WEST JORDAN, UT 84088-4506
(801) 282-2677
(801) 282-2050
Mailing address
3354 W 7800 S, WEST JORDAN, UT 84088-4506
(801) 282-2677
(801) 282-2050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
175335-1206
UT
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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