Provider Demographics
NPI:1699145029
Name:ABRAHAMSON, MARY ANN (NP)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:435-849-1469
Mailing Address - Fax:
Practice Address - Street 1:971 W 1200 S
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-2007
Practice Address - Country:US
Practice Address - Phone:435-849-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4737515-8900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care