Dominique Stay Tecklenburg, PA-C

NPI #1639877475 in Orem, Utah

Provider Information

NPI Number: 1639877475
Entity Type: Individual
Name: Dominique Stay Tecklenburg, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Feb 21, 2023
Last Updated: Feb 21, 2023

Practice Location

Address: 435 S 660 W
City: Orem
State: Utah
ZIP Code: 84058-6078
Phone: (801) 691-4980

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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