Individual
NANCY FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPAS
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
6300 SAGEWOOD DR STE H-397, PARK CITY, UT 84098-7502
(801) 448-2882
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7336957-1206
UT
363AM0700X
Medical Physician Assistant
7336957-1206
UT
Other
Enumeration date
06/21/2007
Last updated
04/03/2017
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