Individual
NHI Q PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5640 S 3500 W, ROY, UT 84067-9158
(801) 773-2838
(801) 418-0941
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
12473011-1206
UT
Other
Enumeration date
10/12/2021
Last updated
10/21/2021
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