Provider Demographics
NPI:1821697681
Name:WOODROW, TAYLOR OLIVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:OLIVIA
Last Name:WOODROW
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 E BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3301
Mailing Address - Country:US
Mailing Address - Phone:435-901-8046
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-7533
Practice Address - Country:US
Practice Address - Phone:435-901-8046
Practice Address - Fax:706-868-8375
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2021-11-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant