Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Robert Ivan Wollenzien

Individual provider Physician Assistant · NPI 1831674092

Robert Ivan Wollenzien is a Physician Assistant in Salem, Utah. Qualified in 2018, 8 years ago. Practices with Revere Health PC, a 410-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Utah.

Years since qualifying
8
Licensed in
UT
In the registry since
2018

Practice location Address checks out

555 W Sr 164
Salem, UT 84653
Phone: (801) 465-4813
Fax: (801) 812-5433
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10990701-1206 (UT)

Record details

NPI number1831674092
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 3, 2018
Last updated in NPPESNovember 27, 2023
Certification dateApril 17, 2020
Mailing address1055 N 500 W, Attn. Credentialing, Provo, UT 84604

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Salem