Individual
IVANA JOURDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4254 S LYNNE LN, HOLLADAY, UT 84124-2760
(602) 717-1963
Mailing address
4254 S LYNNE LN, HOLLADAY, UT 84124-2760
(602) 717-1963
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11316423-4701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11316423-4701
11316423-4701
UT
Enumeration date
12/28/2020
Last updated
12/28/2020
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