Individual
JEAN S HOLLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
425 E 5350 S, SUITE 335, OGDEN, UT 84405-6946
(801) 475-8600
(801) 771-1330
Mailing address
425 E 5350 S, SUITE 335, OGDEN, UT 84405-6946
(801) 475-8600
(801) 771-1330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
268114-1206
UT
363A00000X
Physician Assistant
PA10003282
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00474004
RR MEDICARE
UT
Enumeration date
08/17/2006
Last updated
07/22/2008
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