Healthcare Provider Details

I. General information

NPI: 1093226250
Provider Name (Legal Business Name): DANELE CEBROWSKI CHADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5171 S COTTONWOOD ST
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-428-4257
  • Fax:
Mailing address:
  • Phone: 801-507-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10531414-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: