Provider Demographics
NPI:1366927808
Name:TOPHAM, MAREN (NP)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:
Last Name:TOPHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:395 W BULLDOG BLVD STE 702
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3333
Practice Address - Country:US
Practice Address - Phone:801-357-1700
Practice Address - Fax:801-357-1699
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360317-4405363L00000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology