Terry Russell Van Wormer, PA-C

NPI #1467439505 in Layton, Utah

Provider Information

NPI Number: 1467439505
Entity Type: Individual
Name: Terry Russell Van Wormer, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Dec 29, 2005
Last Updated: Jul 21, 2022

Practice Location

Address: 2121 N 1700 W
City: Layton
State: Utah
ZIP Code: 84041-8803
Phone: (801) 773-4840

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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