Individual
MALLORY IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5121 S COTTONWOOD DR, BUILDING 2 STE 320, MURRAY, UT 84107
(801) 507-3380
Mailing address
5171 S COTTONWOOD ST STE 210, MURRAY, UT 84107-5718
(801) 507-3380
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12106313-1206
UT
363A00000X
Physician Assistant
PA-2213
ID
Other
Enumeration date
06/08/2020
Last updated
10/25/2022
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