Individual
JEANETTE C HEPBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
286 N GATEWAY DR, PROVIDENCE, UT 84332-9733
(435) 755-9174
(435) 755-9148
Mailing address
286 N GATEWAY DR, PROVIDENCE, UT 84332-9733
(435) 755-9174
(435) 755-9148
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0329116-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D5945
—
UT
Enumeration date
01/21/2009
Last updated
01/21/2009
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