Provider Demographics
NPI:1063843183
Name:PITTMAN, MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 N 1650 W
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5066
Mailing Address - Country:US
Mailing Address - Phone:801-491-3910
Mailing Address - Fax:801-491-3911
Practice Address - Street 1:763 N 1650 W
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-5066
Practice Address - Country:US
Practice Address - Phone:801-491-3910
Practice Address - Fax:801-491-3911
Is Sole Proprietor?:No
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6989568-1206363AM0700X
UT6989568-8906363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical