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General NPI Number Information
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NPI Number | 1295970515
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Entity Type | Individual
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Provider Name | STEPHANIE BOULTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1265 E FORT UNION BLVD STE 120
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84047-1845
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Country | US
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Telephone | 801-917-5561
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Fax | 800-775-1064
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Provider Business Mailing Address
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Address Line | 8132 S 3500 E
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-5956
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Country | US
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Telephone | 801-995-1235
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Fax | 800-775-1064
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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 |
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License Number State |
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