Provider Demographics
NPI:1376909614
Name:WEBB, JACK Y JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:Y
Last Name:WEBB
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 E 2900 SOUTH
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:UT
Mailing Address - Zip Code:84078
Mailing Address - Country:US
Mailing Address - Phone:801-472-8415
Mailing Address - Fax:435-725-6889
Practice Address - Street 1:1842 E 2900 S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:UT
Practice Address - Zip Code:84078-5110
Practice Address - Country:US
Practice Address - Phone:180-472-8415
Practice Address - Fax:435-725-6889
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT282651-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse