Provider Demographics
NPI:1841064805
Name:JAHN, JENNIE TESS (NP)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:TESS
Last Name:JAHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 W BLACKSHEAR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7709
Mailing Address - Country:US
Mailing Address - Phone:801-448-5784
Mailing Address - Fax:
Practice Address - Street 1:4304 W BLACKSHEAR DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-7709
Practice Address - Country:US
Practice Address - Phone:801-448-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5999515-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily