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Individual

JAMIE COY GRANGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2245 N 400 E, STE 301, LOGAN, UT 84341-1892
(435) 753-7880
Mailing address
2245 N 400 E, STE 301, LOGAN, UT 84341
(435) 753-7880

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
95341561206
UT

Other

Enumeration date
09/25/2015
Last updated
06/24/2022
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