Individual
BRANDON SHAWN MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11760 S 700 E STE 112, DRAPER, UT 84020-6605
(801) 882-9995
(801) 882-9994
Mailing address
280 S MAIN ST, BOUNTIFUL, UT 84010-6236
(801) 505-0821
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/14/2024
Last updated
05/09/2024
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