Provider Demographics
NPI:1477098416
Name:MUIR, MEGAN GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:GRACE
Last Name:MUIR
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 1:515 E 6TH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84103-6008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 E SOUTH TEMPLE
Practice Address - Street 2:#508
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-1525
Practice Address - Country:US
Practice Address - Phone:801-531-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9758257-1206363A00000X
UTMM4109612363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical