MEDICARE: MRS. DANA WELLER 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	363AM0700X	Medical Physician Assistant	6543672-1206	UT

General Provider Information

NPI Number	:	1750524229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA WELLER PA-C

Provider Business Mailing Address
First Line	:	3173 ALTA HILLS DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84093-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3173 E ALTA HILLS DR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84093-2113
Country	:	US
Telephone Number	:	801-493-5395
Fax Number	:

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	01/14/2013

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