Provider Demographics
NPI:1578814505
Name:KAMMERMAN, MELANIE CHE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:CHE
Last Name:KAMMERMAN
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 1:2390 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2027
Mailing Address - Country:US
Mailing Address - Phone:801-975-1600
Mailing Address - Fax:801-978-2693
Practice Address - Street 1:2390 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2027
Practice Address - Country:US
Practice Address - Phone:801-975-1600
Practice Address - Fax:801-978-2693
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8428681-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant