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NPI Code Detail

MEDICARE: NAOMI LANDRY PA-C

MEDICARE: NAOMI LANDRY 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 Assistant11770693-1206UT

General Provider Information

NPI Number : 1851916464
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAOMI LANDRY PA-C
Provider Business Mailing Address
First Line : 517 W 100 N STE 110
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9826
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 517 W 100 N STE 110
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9826
Country : US
Telephone Number : 435-755-6075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2020
Last Update Date : 06/09/2020

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Directions to “ NAOMI LANDRY PA-C” Practice Location

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