MEDICARE: ADRIENNE MCMASTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4985108-1206	UT
2	363AM0700X	Medical Physician Assistant	4985108-1206	UT

General Provider Information

NPI Number	:	1003095373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE MCMASTER PA-C

Provider Business Mailing Address
First Line	:	274 N MAIN ST
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321-3915
Country	:	US
Telephone Number	:	435-753-1600
Fax Number	:	435-753-9521

Provider Business Practice Location Address
First Line	:	2380 N 400 E STE B
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-1756
Country	:	US
Telephone Number	:	435-752-5741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/20/2021

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Directions to “ ADRIENNE MCMASTER PA-C” Practice Location

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