Individual
SIERRA BOLLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3336 SOUTH 4155 WEST #102, WEST VALLEY, UT 84120
(801) 964-3925
Mailing address
3336 SOUTH 4155 WEST #102, WEST VALLEY, UT 84120
(801) 964-3925
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10977713-1206
UT
363AS0400X
Surgical Physician Assistant
10977713-1206
UT
Other
Enumeration date
09/18/2018
Last updated
11/13/2024
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