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General NPI Number Information
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NPI Number | 1750818241
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Entity Type | Individual
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Provider Name | TERI JUNKO DEMILLE PA-C, MPH, MSHS
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Gender | Female
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 2084 N ROBINS DR STE A
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City | LAYTON
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State | UT
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Zip | 84041-1118
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Country | US
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Telephone | 801-773-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 2084 N ROBINS DR STE A
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City | LAYTON
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State | UT
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Zip | 84041-1118
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Country | US
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Telephone | 801-773-8644
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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 | 0110005486
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10071253-1206
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License Number State | UT
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