Provider Demographics
NPI:1518684448
Name:CHRISTOPULOS, ANNEMARIE
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:CHRISTOPULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 DEER RUN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84405-7160
Mailing Address - Country:US
Mailing Address - Phone:801-971-1642
Mailing Address - Fax:
Practice Address - Street 1:8212 DEER RUN WAY
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-7160
Practice Address - Country:US
Practice Address - Phone:801-971-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11096359-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily