Individual
DEVIN FAYE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2995 E MIDDLETON WAY, SLC, UT 84124-3055
(801) 597-6419
Mailing address
2995 E MIDDLETON WAY, SLC, UT 84124-3055
(801) 597-6419
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
IN PROCESS
UT
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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