Individual
MR. JORDAN MITCHELL PACKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
996 S 200 E APT 105, SALT LAKE CITY, UT 84111-4253
(970) 818-1390
Mailing address
996 S 200 E APT 105, SALT LAKE CITY, UT 84111-4253
(970) 818-1390
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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