Provider Demographics
NPI:1508900127
Name:MAIR, ANNA I (C-PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:I
Last Name:MAIR
Suffix:
Gender:F
Credentials:C-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 W 9000 S
Mailing Address - Street 2:#210
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8876
Mailing Address - Country:US
Mailing Address - Phone:801-569-5328
Mailing Address - Fax:801-569-5333
Practice Address - Street 1:3570 W 9000 S
Practice Address - Street 2:#210
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8876
Practice Address - Country:US
Practice Address - Phone:801-569-5328
Practice Address - Fax:801-569-5333
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT268934-1206363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical