Healthcare Provider Details

I. General information

NPI: 1386255446
Provider Name (Legal Business Name): MICHELLE R CROYLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 UINTA WAY UNIT E2
PARK CITY UT
84098-7685
US

IV. Provider business mailing address

1784 UINTA WAY UNIT E2
PARK CITY UT
84098-7685
US

V. Phone/Fax

Practice location:
  • Phone: 435-604-0160
  • Fax: 435-731-8328
Mailing address:
  • Phone: 435-604-0160
  • Fax: 435-731-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13007674-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95160449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: