Healthcare Provider Details

I. General information

NPI: 1588079347
Provider Name (Legal Business Name): ANGELA SALVESON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA K BACHAND

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W CANYON CREST RD STE 200
ALPINE UT
84004-1966
US

IV. Provider business mailing address

155 W CANYON CREST RD STE 200
ALPINE UT
84004-1966
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-9851
  • Fax: 801-763-9852
Mailing address:
  • Phone: 801-763-9851
  • Fax: 801-763-9852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0553
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10376280-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: