Provider Demographics
NPI:1477673291
Name:MARURI, ANN (DNP, CPNP)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:MARURI
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 N 2000 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8638
Mailing Address - Country:US
Mailing Address - Phone:801-774-8888
Mailing Address - Fax:801-825-8519
Practice Address - Street 1:1477 N 2000 W
Practice Address - Street 2:SUITE C
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8638
Practice Address - Country:US
Practice Address - Phone:801-774-8888
Practice Address - Fax:801-825-8519
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1477673291363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477673291Medicaid