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Individual

JASON D HENRIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1055 N 300 W STE 308, PROVO, UT 84604-3373
(801) 379-6700
(801) 379-6800
Mailing address
1055 N 300 W STE 308, PROVO, UT 84604-3373
(801) 379-6700
(801) 379-6800

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4746028-4405
UT

Other

Enumeration date
12/28/2007
Last updated
12/28/2007
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