Individual
JEAN GROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 N 1900 E RM 4A100, SALT LAKE CITY, UT 84132-0002
(801) 585-7676
Mailing address
3673 S 805 E APT 1, SALT LAKE CITY, UT 84106-4637
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10491953-1206
UT
363AM0700X
Medical Physician Assistant
Primary
10491953-1206
UT
Other
Enumeration date
10/11/2017
Last updated
11/02/2021
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