| Doctor Name: | PEGGY ANNE JEROME |
| NPI Number: | 1013001247 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 278825-4405 |
| Business Practice Address: | 8537 Redwood Rd Suite A - Main Level West Jordan, UT - 840889311 |
| Business Phone Number: | 8015682898 |
| Business Fax Number: | |
| Mailing Address: | 1952 Fort Union Blvd, 209 SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841216877 |
| Phone Number: | 8019422729 |
| Fax Number: | 8019425638 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 278825-4405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |