Individual
JESSICA MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113
(801) 662-2950
Mailing address
1592 E 925 S, CLEARFIELD, UT 84015-2377
(435) 730-4087
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6591001-4405
UT
363L00000X
Nurse Practitioner
6591001-8900
UT
Other
Enumeration date
06/15/2015
Last updated
06/14/2018
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