Individual
MADISON MICHELLE POWELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
395 W COUGAR BLVD STE 704, PROVO, UT 84604-3333
(801) 357-3242
Mailing address
1219 N BAYCREST DR, SARATOGA SPRINGS, UT 84045-5004
(801) 362-1649
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14175034-1206
UT
Other
Enumeration date
05/08/2023
Last updated
09/10/2024
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