Provider Demographics
NPI:1457638736
Name:EHRSAM, MARY (PA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:EHRSAM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2051 W CANYON VIEW DR APT 27
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 482
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362-9998
Practice Address - Country:US
Practice Address - Phone:01181611-743-7015
Practice Address - Fax:01181611-743-0229
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant