Provider Demographics
NPI:1174531289
Name:CARVER, JEANLEE F (APRN-BC, CPNP)
Entity type:Individual
Prefix:
First Name:JEANLEE
Middle Name:F
Last Name:CARVER
Suffix:
Gender:F
Credentials:APRN-BC, CPNP
Other - Prefix:
Other - First Name:JEANLEE
Other - Middle Name:F
Other - Last Name:FERRO, BEANMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:801-721-3211
Mailing Address - Fax:
Practice Address - Street 1:2408 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2712
Practice Address - Country:US
Practice Address - Phone:801-778-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT202382-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics