MEDICARE: NATALIE REINHOLD PA

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	12658125-1206
2	363A00000X	Physician Assistant	12658135-1206	UT

General Provider Information

NPI Number	:	1578215521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE REINHOLD PA

Provider Business Mailing Address
First Line	:	280 S MAIN ST
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-6236
Country	:	US
Telephone Number	:	801-505-0821
Fax Number	:	801-505-0803

Provider Business Practice Location Address
First Line	:	4133 W PIONEER PKWY STE 120
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2059
Country	:	US
Telephone Number	:	801-966-1403
Fax Number	:	801-964-6478

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

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	02/23/2024

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Directions to “ NATALIE REINHOLD PA” Practice Location

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