Healthcare Provider Details

I. General information

NPI: 1750524229
Provider Name (Legal Business Name): DANA WELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 E ALTA HILLS DR
COTTONWOOD HEIGHTS UT
84093-2113
US

IV. Provider business mailing address

3173 ALTA HILLS DR
COTTONWOOD HEIGHTS UT
84093-0000
US

V. Phone/Fax

Practice location:
  • Phone: 801-493-5395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6543672-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: