Jacob Wallace, A.P.R.N

NPI 1639915911 · on the registry since 2024 · sole proprietor

Practice

Address: 630 E 1400 N Ste 135
Logan, UT 84341
Phone: (435) 787-8146
Fax: (435) 787-8149
Organisation at this address: Vernon Medical Pllc
Vernon Medical Pllc
Sterling Medical Llc
Sterling Provider Group
Back At Work Of Utah Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 22

Registry record

Primary taxonomy: 363LF0000X
363LF0000X
Also registered as: 363LG0600X
Licence states on file: UT
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2024-08-23

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah