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NPI Code Detail

MEDICARE: HEATHER BENALLY PA-C

MEDICARE: HEATHER BENALLY 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
1363AM0700XMedical Physician Assistant5655758-1206UT

General Provider Information

NPI Number : 1659327153
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER BENALLY PA-C
Provider Business Mailing Address
First Line : 767 E 750 N
Second Line :
City : AMERICAN FORK
State : UT
Zip : 84003-1584
Country : US
Telephone Number : 801-492-1999
Fax Number : 801-492-1991
Provider Business Practice Location Address
First Line : 1912 W 930 N
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-4104
Country : US
Telephone Number : 801-492-1999
Fax Number : 801-492-1991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 07/08/2007

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Directions to “ HEATHER BENALLY PA-C” Practice Location

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