Individual
MRS. STACEY MICHELLE ROSEVEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3116 S 2700 E, SALT LAKE CITY, UT 84109-2823
(801) 201-2475
Mailing address
3116 S 2700 E, SALT LAKE CITY, UT 84109-2823
(801) 201-2475
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4833428-1206
UT
363A00000X
Physician Assistant
4833428-8906
UT
Other
Enumeration date
02/27/2014
Last updated
02/27/2014
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