ANNA LYNN GUSTAVESON (NPI# 1659820231) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1659820231 |
Entity Type | Individual |
Full Name | ANNA LYNN GUSTAVESON |
Credential | PA-C |
Practice Address |
5121 S Cottonwood St Murray UT 84107 |
Mailing Address |
5121 S Cottonwood St Murray UT 84107-5701 |
Practice Telephone | 8015073380 |
Mailing Telephone | 8015073380 |
Enumeration Date | 2016-09-24 |
Last Update Date | 2019-11-02 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363A00000X | Physician Assistant | 6429 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
11419794 | UT | Physician Assistants & Advanced Practice Nursing Providers |
Address | Telephone Number | Fax Number |
---|---|---|
635 E Baseline Rd, Phoenix, AZ 850426551 | 6022437277 | 6022431235 |
Street Address |
5121 S COTTONWOOD ST |
City | MURRAY |
State | UT |
Zip Code | 84107 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609873595 | Sarah Dawn Majercik | Surgery | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2005-07-07 |
1093312183 | Cherysh Hubbard Stock | Obstetrics & Gynecology | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-10-02 |
1922605062 | Sydney Schuessler | Occupational Therapist | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-10-01 |
1790398931 | Elayne Manuela Pereira | Physical Therapist | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-08-27 |
1205449436 | Jared Hunt | Physical Therapist | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-08-27 |
1386256428 | Sarah Emily Boyt | Dietitian, Registered | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-08-19 |
1972111417 | Megan Neiheiser | Occupational Therapist | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-07-21 |
1114535515 | Cory Ray Briggle | Occupational Therapist | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-07-21 |
1528676509 | Melanie Nicole Emmerson | Genetic Counselor, MS | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-07-16 |
1205452844 | Kendall Snyder | Genetic Counselor, MS | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2020-06-19 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902410517 | Brielle Nicole Poulter | Student in an Organized Health Care Education/Training Program | 345 East 4500 So #260, Murray, UT 84107 | 2020-09-01 |
1467016592 | Ashlee Brown | Social Worker | C-134, 5284 Commerce Drive, Murray, Murray, UT 84107 | 2019-04-24 |
1568940633 | Samantha Duff | Occupational Therapist | 5770 S Fashion Blvd, Bldg 5 Ste 201, Murray, UT 84107 | 2018-08-01 |
1881185247 | Derek John Sharp | Occupational Therapist | 5770 S Fashion Blvd, Bldg #5, Suite 210, Murray, UT 84107 | 2018-05-22 |
1093223091 | Erin Nicole Hill | Counselor | 345 East 4500 South Suite 260, Murray, UT 84107 | 2018-01-12 |
1588171219 | Nicole Danielle Jensen | Counselor | 345 East 4500 South, Suite 260, Murray, UT 84107 | 2018-01-03 |
1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
1043739667 | Karyn K Hodge | Audiologist | 4500 So. 777. E. Ste #110, Murray, UT 84107 | 2017-09-14 |
1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
1396261152 | Megan Lehane Delano | Plastic Surgery | 5169 Cottonwood St Ste 420, Murray, UT 84107 | 2017-08-14 |
Find all providers in zip 84107 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891230041 | Sarah Danielle Mendenhall | Physician Assistant | 5169 S Cottonwood St Ste 600, Murray, UT 84107-6771 | 2016-12-26 |
1982869210 | Scott D Taylor | Physician Assistant | 5323 Woodrow St Ste 102, Murray, UT 84107-5853 | 2008-07-25 |
1528052289 | Mccall Fagan | Physician Assistant | 5323 South Woodrow Street, Suite 200, Murray, UT 84107 | 2005-09-08 |
1154315521 | Lorie Lee | Physician Assistant | 5848 Fashion Blvd, Murray, UT 84107-6121 | 2005-08-31 |
1366877029 | Robert Chad Bannon | Physician Assistant | 5121 S Cottonwood St, Ste 950, Murray, UT 84107-5701 | 2013-09-12 |
1295071801 | Jason Holden | Physician Assistant | 5848 S Fashion Blvd, Murray, UT 84107-6121 | 2012-12-31 |
1083917355 | John Dudley Duross | Physician Assistant | 5121 South Cottonwood Street, Murray, UT 84157 | 2010-12-08 |
1154639276 | Kristi Reinschmidt | Physician Assistant | 5169 Cottonwood St, Suite 320, Murray, UT 84107-6767 | 2010-09-23 |
1568773935 | Amanda Dunn | Physician Assistant | 5770 S 250 E Ste 285, Murray, UT 84107-8194 | 2010-06-30 |
1821240243 | Joseph Lawrence Sartori | Physician Assistant | 5444 Green St, Murray, UT 84123-5632 | 2008-10-16 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.