Provider Demographics
NPI:1518538842
Name:ABERTON, SAMANTHA JO (APRN FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:ABERTON
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:PARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1160 E 3900 S STE 2000
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1236
Mailing Address - Country:US
Mailing Address - Phone:801-266-3418
Mailing Address - Fax:
Practice Address - Street 1:1160 E 3900 S STE 2000
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1236
Practice Address - Country:US
Practice Address - Phone:801-266-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10846422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner