Provider Demographics
NPI:1265630313
Name:WOLD, JANA (MD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:
Last Name:WOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1352 SOUTH 900 EAST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105
Mailing Address - Country:US
Mailing Address - Phone:801-647-5383
Mailing Address - Fax:801-587-8039
Practice Address - Street 1:175 N MEDICAL DR FL 3
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-9935
Practice Address - Fax:801-587-8039
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6359075-12052084V0102X
UT6359075-8905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology