Healthcare Provider Details

I. General information

NPI: 1336450691
Provider Name (Legal Business Name): TIFFANY QUINN REES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S 300 E
MURRAY UT
84107-6157
US

IV. Provider business mailing address

5848 S 300 E
MURRAY UT
84107-6157
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4100
  • Fax:
Mailing address:
  • Phone: 801-314-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7615349-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: