Basic Information
Provider Information
NPI: 1902488844
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARFIELD
FirstName: JOLYNN
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1840 S 1300 E
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841053617
CountryCode: US
TelephoneNumber: 8018322200
FaxNumber:  
Practice Location
Address1: 1055 N 300 W STE 401
Address2:  
City: PROVO
State: UT
PostalCode: 846043306
CountryCode: US
TelephoneNumber: 8013577499
FaxNumber: 8013735980
Other Information
ProviderEnumerationDate: 04/21/2021
LastUpdateDate: 08/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X9772467-4405UTY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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