Individual
MADISON RAE GROBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 GOLF COURSE RD STE E, LOGAN, UT 84321-5934
(435) 999-4059
Mailing address
115 GOLF COURSE RD STE E, LOGAN, UT 84321-5934
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA-2019
ID
Other
Enumeration date
07/01/2020
Last updated
04/29/2026
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