Provider Demographics
NPI:1104115591
Name:PETRIE, JO ANN (MS)
Entity type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:
Last Name:PETRIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 E 275 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-5085
Mailing Address - Country:US
Mailing Address - Phone:801-224-9532
Mailing Address - Fax:
Practice Address - Street 1:100 S. UNIVERSITY AVE.
Practice Address - Street 2:3200
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601
Practice Address - Country:US
Practice Address - Phone:801-851-7127
Practice Address - Fax:801-851-7198
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator