Doctor Name: | MRS. DANA WELLER |
NPI Number: | 1750524229 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 6543672-1206 |
Business Practice Address: | 3173 E Alta Hills Dr Cottonwood Heights, UT - 840932113 |
Business Phone Number: | 8014935395 |
Business Fax Number: | |
Mailing Address: | 3173 Alta Hills Dr, COTTONWOOD HEIGHTS |
State: | UT |
Postal Code: | 840930000 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/14/2009 |
NPI Last Update Date: | 01/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 6543672-1206 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |