Basic Information
| Provider Information | |||||||||
| NPI: | 1093226250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHADA | ||||||||
| FirstName: | DANELE | ||||||||
| MiddleName: | CEBROWSKI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5171 S COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015073380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5121 S COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014284257 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10531414-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.