Healthcare Provider Details

I. General information

NPI: 1740590769
Provider Name (Legal Business Name): MARY MICHELLE CASHMAN THOMAS MSN, APRN-BC, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 S COTTONWOOD ST # L-2
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5226 FRONTIER DR SUITE B299
MORGAN UT
84050-9734
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-3416
  • Fax: 801-263-3428
Mailing address:
  • Phone: 801-892-0135
  • Fax: 801-266-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number336206-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number336206-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: