Individual
MRS. MARY MENLOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6095 FASHION BLVD, MURRAY, UT 84107-7397
(801) 581-2955
Mailing address
PO BOX 3208, SALT LAKE CITY, UT 84110-3208
(801) 587-6340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
54164451206
UT
363AM0700X
Medical Physician Assistant
Primary
54164451206
UT
Other
Enumeration date
10/25/2006
Last updated
05/17/2012
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