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Individual

MR. JACOB ANTHONY WOODS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSN, PMHNP-BC, APRN

Contact information

Practice address
688 E VINE ST, MURRAY, UT 84107-5549
(801) 436-6556
Mailing address
14073 S CHARDONNAY WAY, BLUFFDALE, UT 84065-3857
(315) 854-0016

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
9471119-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9471119-4405
UT

Other

Enumeration date
03/04/2024
Last updated
03/07/2024
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