MEDICARE: YVONNE K MARLEY 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	3153	AZ
2	363A00000X	Physician Assistant	055-0031003	VT
3	363A00000X	Physician Assistant	34195	MT
4	363A00000X	Physician Assistant	748	NH

General Provider Information

NPI Number	:	1477584415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE K MARLEY PA C

Provider Business Mailing Address
First Line	:	1338 S FOOTHILL DR # 333
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2321
Country	:	US
Telephone Number	:	801-754-6051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 S FOOTHILL DR # 333
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2321
Country	:	US
Telephone Number	:	801-754-6051
Fax Number	:	801-210-0476

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/20/2026

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