Provider Demographics
NPI:1326346115
Name:JEWELL, MARY I (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:I
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 NORTH DIXIE DRIVE
Mailing Address - Street 2:UNIT 17
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-668-5209
Mailing Address - Fax:
Practice Address - Street 1:265 NORTH DIXIE DRIVE
Practice Address - Street 2:UNIT 17
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-668-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health