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General NPI Number Information
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NPI Number | 1043324551
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Entity Type | Individual
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Provider Name | DIANA FLETCHER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 722 SHEPARD LN SUITE 102
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City | FARMINGTON
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State | UT
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Zip | 84025-3845
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Country | US
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Telephone | 801-447-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 COUNTRY HILLS DR
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City | OGDEN
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State | UT
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Zip | 84403-2512
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Country | US
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Telephone | 801-391-1882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5582820-1206
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License Number State | UT
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