Individual
ROBERT IVAN WOLLENZIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 WEST SR 164, SALEM, UT 84653
(801) 465-4813
(801) 812-5433
Mailing address
1055 N 500 W, ATTN. CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10990701-1206
UT
Other
Enumeration date
10/03/2018
Last updated
11/27/2023
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