Healthcare Provider Details

I. General information

NPI: 1922797620
Provider Name (Legal Business Name): MARY ROSBACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E 750 N
OREM UT
84097-4345
US

IV. Provider business mailing address

1350 E 750 N
OREM UT
84097-4345
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-2273
  • Fax:
Mailing address:
  • Phone: 801-852-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14185235-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: