=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396754008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ELIZABETH HUGHES PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5734 S 1475 E STE 300
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-475-5210
-----------------------------------------------------
Fax | 801-475-5209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5734 S 1475 E STE 300
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-475-5210
-----------------------------------------------------
Fax | 801-475-5209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 055-0030622
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 14181147-1206
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------