Provider Demographics
NPI:1487922266
Name:CHANDLER, REBECKA DAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:REBECKA
Middle Name:DAVIS
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2287 S 2060 W
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2801
Mailing Address - Country:US
Mailing Address - Phone:801-440-5111
Mailing Address - Fax:
Practice Address - Street 1:1280 E STRINGHAM AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2490
Practice Address - Country:US
Practice Address - Phone:801-581-2000
Practice Address - Fax:801-585-2891
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT8121398-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant