Provider Demographics
NPI:1417681131
Name:ZAMPANO, ANNAROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNAROSE
Middle Name:
Last Name:ZAMPANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6924
Mailing Address - Country:US
Mailing Address - Phone:801-365-1032
Mailing Address - Fax:801-365-1033
Practice Address - Street 1:6360 S 3000 E STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6924
Practice Address - Country:US
Practice Address - Phone:801-365-1032
Practice Address - Fax:801-365-1033
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12918998-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant