Provider Demographics
NPI:1861005688
Name:AHLSTROM, CARA SUSAN JONES (APRN)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:SUSAN JONES
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 N HAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6881
Mailing Address - Country:US
Mailing Address - Phone:801-540-3846
Mailing Address - Fax:
Practice Address - Street 1:81 N HAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6881
Practice Address - Country:US
Practice Address - Phone:801-540-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9521737-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily