Healthcare Provider Details

I. General information

NPI: 1588558019
Provider Name (Legal Business Name): MADELYN MILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 S ARAPEEN DR
SALT LAKE CITY UT
84108-1218
US

IV. Provider business mailing address

729 S ARAPEEN DR
SALT LAKE CITY UT
84108-1218
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14227908-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: