Organization
AUDREY JANTZEN, M.D. PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUDREY JANTZEN (MANAGER)
(801) 229-1054
Entity
Organization
Contact information
Practice address
3685 N 100 E, SUITE A, PROVO, UT 84604-4594
(801) 229-1954
(801) 426-6338
Mailing address
3685 N 100 E, SUITE A, PROVO, UT 84604-4594
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
66542191205
UT
Other
Enumeration date
08/13/2009
Last updated
08/13/2009
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