Individual
JACQUELINE N BLAKELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5226 FRONTIER DR, MORGAN, UT 84050-9734
(801) 876-3749
Mailing address
5226 FRONTIER DR, MORGAN, UT 84050-9734
(801) 876-3749
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4791430-4405
UT
Other
Enumeration date
06/04/2016
Last updated
06/04/2016
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