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General NPI Number Information
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NPI Number | 1699394429
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Entity Type | Individual
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Provider Name | MARIAH ANN TREADWELL
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Gender | Female
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Dates
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Enumeration Date | 04/12/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 2330 E FORT UNION BLVD
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-3339
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Country | US
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Telephone | 801-308-1013
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Fax |
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Provider Business Mailing Address
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Address Line | 163 E MIDVILLAGE BLVD APT 406
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City | SANDY
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State | UT
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Zip | 84070-1290
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Country | US
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Telephone | 207-740-7348
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | PI46029
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11701316-1701
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License Number State | UT
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