Provider Demographics
NPI:1972328581
Name:JESSEN, NICOLE ERIKA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ERIKA
Last Name:JESSEN
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 1:1867 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2410
Mailing Address - Country:US
Mailing Address - Phone:801-891-3143
Mailing Address - Fax:
Practice Address - Street 1:1867 N 1200 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2410
Practice Address - Country:US
Practice Address - Phone:801-891-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program