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General NPI Number Information
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NPI Number | 1417809757
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Entity Type | Individual
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Provider Name | ANNIE THOMAS NP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 301 W 5400 S
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City | MURRAY
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State | UT
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Zip | 84107-5898
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Country | US
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Telephone | 801-747-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 4870 S HIGHLAND CIR APT 1
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City | HOLLADAY
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State | UT
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Zip | 84117-6021
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Country | US
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Telephone | 801-608-6079
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12462423-4405
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License Number State | UT
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