Individual
JAQUELINE PHOMSOUVANDARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Contact information
Practice address
3100 S NEEDLES HWY STE 600, LAUGHLIN, NV 89029-0815
(801) 485-6166
Mailing address
746 E WINCHESTER ST STE 200, MURRAY, UT 84107-8513
(801) 485-6166
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
10/18/2024
Last updated
10/18/2024
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