Individual
MICHAEL JACOB PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3280 W 3500 S STE B, WEST VALLEY, UT 84119-2627
(801) 979-1351
Mailing address
3739 W 5100 S, TAYLORSVILLE, UT 84129-3527
(138) 522-7513
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
UT
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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