Individual
JALEN MON TIEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
412 MEADOW LN, PROVIDENCE, UT 84332-9821
(435) 363-6400
Mailing address
412 MEADOW LN, PROVIDENCE, UT 84332-9821
(435) 363-6400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/15/2022
Last updated
09/15/2022
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