MEDICARE: MARY E DING FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	196180-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558399477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E DING FNP

Provider Business Mailing Address
First Line	:	154 MYRTLE AVE STE 204
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-4833
Country	:	US
Telephone Number	:	801-266-9300
Fax Number	:	801-266-9305

Provider Business Practice Location Address
First Line	:	154 MYRTLE AVE STE 204
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-4833
Country	:	US
Telephone Number	:	801-266-9300
Fax Number	:	801-266-9305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/20/2021

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