Provider Demographics
NPI:1124006457
Name:JONES, JULIE (CNM, MS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CNM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 W 12600 S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7260
Mailing Address - Country:US
Mailing Address - Phone:801-302-5777
Mailing Address - Fax:801-302-5666
Practice Address - Street 1:3409 W 12600 S
Practice Address - Street 2:SUITE #110
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7260
Practice Address - Country:US
Practice Address - Phone:801-302-5777
Practice Address - Fax:801-302-5666
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212163-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTSO7154Medicare UPIN