Individual
MICHAELA BLEYL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1055 N 500 W STE 101, PROVO, UT 84604-3305
(801) 373-4366
(801) 429-8191
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
12888254-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12888254-1206
UTAH PHYSICIAN ASSISTANT LICENSE
UT
Enumeration date
09/05/2022
Last updated
12/13/2023
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