Individual
YVONNE POTTER FUELLENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5848 FASHION BLVD STE 110, MURRAY, UT 84107-6121
(801) 314-4130
(801) 314-4011
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 314-4130
(801) 314-4011
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
APPLIED
UT
363A00000X
Physician Assistant
Primary
264696-1206
UT
Other
Enumeration date
08/31/2009
Last updated
04/29/2016
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