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General NPI Number Information
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NPI Number | 1396715504
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Entity Type | Individual
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Provider Name | MARY JANE CUMBERLAND APRN
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 1020 S MAIN ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-3176
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Country | US
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Telephone | 801-539-7000
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Fax | 801-539-7050
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Provider Business Mailing Address
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Address Line | 22 Q ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-3950
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Country | US
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Telephone | 801-531-6872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2177194405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2177194405
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License Number State | UT
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