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General NPI Number Information
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NPI Number | 1760673115
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Entity Type | Individual
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Provider Name | MICHAEL SEAN HARLAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 4932 S 3425 W
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City | ROY
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State | UT
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Zip | 84067-8656
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Country | US
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Telephone | 801-309-6174
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Fax |
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Provider Business Mailing Address
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Address Line | 4932 S 3425 W
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City | ROY
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State | UT
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Zip | 84067-8656
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Country | US
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Telephone | 801-309-6174
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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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 | 57954461206
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License Number State | UT
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