Individual
JENNIFER LEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3210 S TETON DR, SALT LAKE CITY, UT 84109-2333
(865) 438-6994
(801) 581-6243
Mailing address
3210 S TETON DR, SALT LAKE CITY, UT 84109-2333
(865) 438-6994
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
10919244-3102
UT
163WP0000X
Pain Management Registered Nurse
101919244-3102
UT
Other
Enumeration date
08/29/2024
Last updated
08/29/2024
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