Healthcare Provider Details

I. General information

NPI: 1144987223
Provider Name (Legal Business Name): CHANDRA LOUISE MARSH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E 9TH AVE STE 205
SALT LAKE CITY UT
84103-3184
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-6100
  • Fax:
Mailing address:
  • Phone: 808-545-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14292803-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: