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NPI Code Detail

MEDICARE: MICHELLE WASDEN PA-C

MEDICARE: MICHELLE WASDEN 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 Assistant349500-1206UT

General Provider Information

NPI Number : 1700875333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE WASDEN PA-C
Provider Business Mailing Address
First Line : PO BOX 5546
Second Line :
City : DENVER
State : CO
Zip : 80217-5546
Country : US
Telephone Number : 801-475-3600
Fax Number : 801-475-3601
Provider Business Practice Location Address
First Line : 1100 W 2700 N
Second Line :
City : PLEASANT VIEW
State : UT
Zip : 84404-4791
Country : US
Telephone Number : 801-475-3600
Fax Number : 801-475-3601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 01/17/2017

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Directions to “ MICHELLE WASDEN PA-C” Practice Location

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