Provider Demographics
NPI:1740590769
Name:CASHMAN THOMAS, MARY MICHELLE (MSN, APRN-BC, ACNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELLE
Last Name:CASHMAN THOMAS
Suffix:
Gender:F
Credentials:MSN, APRN-BC, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5226 FRONTIER DR
Mailing Address - Street 2:SUITE B299
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9734
Mailing Address - Country:US
Mailing Address - Phone:801-892-0135
Mailing Address - Fax:801-266-2362
Practice Address - Street 1:5131 S COTTONWOOD ST # L-2
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-263-3416
Practice Address - Fax:801-263-3428
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336206-4405363L00000X
UT336206-8900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1740590769Medicaid