Provider Demographics
NPI:1184046443
Name:DAILEY, GINTARE (PA-C)
Entity type:Individual
Prefix:
First Name:GINTARE
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINTARE
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2295 S FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4000
Mailing Address - Country:US
Mailing Address - Phone:801-486-3021
Mailing Address - Fax:801-485-6339
Practice Address - Street 1:2295 S FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-4000
Practice Address - Country:US
Practice Address - Phone:801-486-3021
Practice Address - Fax:801-485-6339
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8854435-1206363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical