Individual
MRS. CERISSA NICOLE JOHNSON HETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
975 CHAMBERS ST, SOUTH OGDEN, UT 84403-4591
(801) 387-6200
(801) 387-6234
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11591617-4405
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/27/2022
Last updated
01/13/2023
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