Organization
YOUTHFUL RENEWAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE SLACK (NURSE PRACTITIONER)
(435) 531-9268
Entity
Organization
Contact information
Practice address
517 W ASPEN PEAK DR, SOUTH JORDAN, UT 84095-4128
(435) 531-9268
Mailing address
517 W ASPEN PEAK DR, SOUTH JORDAN, UT 84095-4128
(435) 531-9268
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/02/2024
Last updated
05/02/2024
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