Individual
JACOB BUCKWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5475 S 500 E, OGDEN, UT 84405-6905
(801) 479-2111
Mailing address
1059 N 175 E, LAYTON, UT 84041-2477
(801) 719-0045
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
94443013102
UT
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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