Provider Demographics
NPI:1275264731
Name:LETE, ISABELA ROSE (PA-S)
Entity type:Individual
Prefix:
First Name:ISABELA
Middle Name:ROSE
Last Name:LETE
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 S 1175 E
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1206
Mailing Address - Country:US
Mailing Address - Phone:208-989-8460
Mailing Address - Fax:
Practice Address - Street 1:3115 E LION LN STE 160
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3514
Practice Address - Country:US
Practice Address - Phone:855-255-1750
Practice Address - Fax:855-255-0905
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID191787146N00000X
IDPA-2630207Q00000X, 363A00000X
UT13882004-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine