Individual
NICOLE RENAE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6553 S 5135 W, WEST JORDAN, UT 84081-3817
(801) 980-4576
Mailing address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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