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General NPI Number Information
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NPI Number | 1407246135
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Entity Type | Individual
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Provider Name | TERESA SANDERS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 5169 S COTTONWOOD ST SUITE 520
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City | MURRAY
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State | UT
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Zip | 84107
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Country | US
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Telephone | 801-507-3500
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Fax | 801-507-3505
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Provider Business Mailing Address
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Address Line | 5169 S COTTONWOOD ST SUITE 520
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City | MURRAY
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State | UT
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Zip | 84107
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Country | US
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Telephone | 801-507-3500
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Fax | 801-507-3505
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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 | 50.004282RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 50.004282
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10636633-1206
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License Number State | UT
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