Individual
JEAN STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
412 W 800 N, OREM, UT 84057-3728
(801) 235-7246
(801) 226-4098
Mailing address
283 E 930 S, OREM, UT 84058-5001
(801) 225-6246
(801) 225-1525
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
102228-1206
UT
Other
Enumeration date
01/10/2007
Last updated
10/18/2011
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