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NPI Code Detail

MEDICARE: MRS. JOANNE NICHOLE RICHARDS ROLLS PA-C

MEDICARE: MRS. JOANNE NICHOLE RICHARDS ROLLS 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
1363A00000XPhysician Assistant8433278-1206UT

General Provider Information

NPI Number : 1285984070
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOANNE NICHOLE RICHARDS ROLLS PA-C
Provider Business Mailing Address
First Line : 375 S CHIPETA WAY STE A
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1261
Country : US
Telephone Number : 801-587-3355
Fax Number :
Provider Business Practice Location Address
First Line : 1280 E STRINGHAM AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2490
Country : US
Telephone Number : 801-581-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/22/2022

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