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Individual

JENNICA MARIE VAN BLERKOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
389 S 900 E, SALT LAKE CITY, UT 84102-2310
(385) 282-2750
Mailing address
389 S 900 E, SALT LAKE CITY, UT 84102-2310
(385) 282-2750

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11459479-1206
UT
363AM0700X
Medical Physician Assistant

Other

Enumeration date
07/23/2019
Last updated
12/20/2021
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