Provider Demographics
NPI:1699243337
Name:HASE, JENNA LYNN
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:HASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 S COMMERCE DR STE C134
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5360
Mailing Address - Country:US
Mailing Address - Phone:801-266-4643
Mailing Address - Fax:
Practice Address - Street 1:5284 S COMMERCE DR STE C134
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5360
Practice Address - Country:US
Practice Address - Phone:801-266-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program