Individual
JESSE BENNION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4473 W 13400 N, CORNISH, UT 84308-1743
(435) 213-3123
Mailing address
4473 W 13400 N, CORNISH, UT 84308-1743
(435) 213-3123
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
7701604-3102
UT
Other
Enumeration date
03/31/2017
Last updated
03/31/2017
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