Individual
MRS. PEGGY ELENE JACOBSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
195 W 7200 S, MIDVALE, UT 84047-3703
(801) 565-6900
(801) 569-0899
Mailing address
7454 S 2405 W, WEST JORDAN, UT 84084-3114
(801) 563-0998
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1927543102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107032218101
INTERMTN. HEALTH CARE
UT
01
—
751659
DESERET MUTUAL
UT
01
—
942938348014
CHAMPUS
UT
Enumeration date
01/26/2006
Last updated
07/08/2007
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