Provider Demographics
NPI:1841086899
Name:WILLIAMS, MARA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N MANILA CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9514
Mailing Address - Country:US
Mailing Address - Phone:801-623-1823
Mailing Address - Fax:
Practice Address - Street 1:1425 N MANILA CT
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-9514
Practice Address - Country:US
Practice Address - Phone:801-623-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT350964-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty