Provider Demographics
NPI:1295970515
Name:BOULTER, STEPHANIE (PA-C)
Entity type:Individual
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First Name:STEPHANIE
Middle Name:
Last Name:BOULTER
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Credentials:PA-C
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Mailing Address - Street 1:8132 S 3500 E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5956
Mailing Address - Country:US
Mailing Address - Phone:801-995-1235
Mailing Address - Fax:801-572-9992
Practice Address - Street 1:1265 E FORT UNION BLVD STE 120
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-1845
Practice Address - Country:US
Practice Address - Phone:801-917-5561
Practice Address - Fax:801-572-9992
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2025-04-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant