Provider Demographics
NPI:1033995360
Name:URCH, JENNIFER MELINDA (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MELINDA
Last Name:URCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E 9TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3182
Mailing Address - Country:US
Mailing Address - Phone:801-408-5700
Mailing Address - Fax:
Practice Address - Street 1:370 E 9TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3182
Practice Address - Country:US
Practice Address - Phone:801-408-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95088181163WE0003X
CA95027141363LF0000X
UT12394362-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily