Individual
REBECCA DIANE SHIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-4074
(801) 581-7818
Mailing address
30 N 1900 E RM 5R218, SALT LAKE CITY, UT 84132-0002
(801) 581-7818
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11213974-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
08/03/2021
Last updated
12/20/2021
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