NPI 1063645554 · live from the CMS NPI Registry
Yvonne Potter Fuellenbach, PA-C
Physician Assistant in Murray, UT. National Provider Identifier 1063645554, active.
NPI record
| NPI | 1063645554 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 5848 Fashion Blvd Ste 110, Murray, UT 84107 |
| Practice phone | 801-314-4130 |
| Mailing address | Po Box 27128, Salt Lake City, UT 84127 |
| Enumerated | August 31, 2009 |
| Last updated | April 29, 2016 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery | 207XS0114X | applied (UT) |
| Physician Assistant primary | 363A00000X | 264696-1206 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.