Healthcare Provider Details

I. General information

NPI: 1851672034
Provider Name (Legal Business Name): MARIA ADDISON MSN-BC, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR RM 2521
SALT LAKE CITY UT
84132-8100
US

IV. Provider business mailing address

50 N MEDICAL DR RM 2521
SALT LAKE CITY UT
84132-8100
US

V. Phone/Fax

Practice location:
  • Phone: 801-830-4630
  • Fax:
Mailing address:
  • Phone: 801-830-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number197998-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number197998-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: