Individual
JERRY ANTONY HADLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
684 E 320 S, SALEM, UT 84653-8532
(801) 615-3292
Mailing address
684 E 320 S, SALEM, UT 84653-8532
(801) 615-3292
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
7091442-4405
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
7091442-8900
UT
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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