Individual
BREELYN JAN VAN LEEUWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MSPA
Contact information
Practice address
1055 N 500 W STE 211, PROVO, UT 84604-3305
(801) 357-7327
(801) 375-8860
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 812-4673
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8808600-1206
UT
Other
Enumeration date
11/12/2013
Last updated
01/09/2014
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