Individual
NATHAN SANBORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
555 W SR 164, SALEM, UT 84653-8465
(801) 465-4896
(801) 465-3267
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604-5015
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13074268-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/29/2022
Last updated
10/28/2022
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