Individual
STACI JANAE BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3419
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
12602904-8906
UT
363AM0700X
Medical Physician Assistant
Primary
12602904-8906
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
UT
Other
Enumeration date
06/13/2020
Last updated
10/14/2024
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