Provider Demographics
NPI:1053512665
Name:MIDGLEY, WENDY (PA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MIDGLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2678 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4330
Mailing Address - Country:US
Mailing Address - Phone:801-808-2970
Mailing Address - Fax:
Practice Address - Street 1:10462 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8501
Practice Address - Country:US
Practice Address - Phone:801-352-9500
Practice Address - Fax:801-352-9502
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6324228-48102255A2300X
UT6324228-1206363A00000X
UT6324228-126PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant