MEDICARE: MARY ANN ABRAHAMSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	4737515-8900	UT

General Provider Information

NPI Number	:	1699145029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN ABRAHAMSON NP

Provider Business Mailing Address
First Line	:	PO BOX 30180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0180
Country	:	US
Telephone Number	:	435-849-1469
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 W 1200 S
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84087-2007
Country	:	US
Telephone Number	:	435-849-1469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	10/19/2015

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