Provider Demographics
NPI:1841970662
Name:JEWETT, MCCALL (NP)
Entity type:Individual
Prefix:
First Name:MCCALL
Middle Name:
Last Name:JEWETT
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:PO BOX 30079
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0079
Mailing Address - Country:US
Mailing Address - Phone:801-375-8858
Mailing Address - Fax:801-429-8180
Practice Address - Street 1:555 W SR 164
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653
Practice Address - Country:US
Practice Address - Phone:801-465-4896
Practice Address - Fax:801-465-0606
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8339669-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily