Healthcare Provider Details

I. General information

NPI: 1619909017
Provider Name (Legal Business Name): SHIRLEY L. ALA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 TURNER ST UNIT 2
AUBURN ME
04210-6314
US

IV. Provider business mailing address

2295 FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 207-330-3900
  • Fax: 207-330-3940
Mailing address:
  • Phone: 801-486-3021
  • Fax: 801-485-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2166771206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: