Individual
MS. MARY JANE CUMBERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1020 S MAIN ST, SALT LAKE CITY, UT 84101-3176
(801) 539-7000
(801) 539-7050
Mailing address
22 Q ST, SALT LAKE CITY, UT 84103-3950
(801) 531-6872
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2177194405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2177194405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003104021
RCAR
UT
01
—
107029319101
U006
UT
01
—
857364
U002--DESERET MUTUAL
UT
01
—
94293834884101A008
U009
UT
01
—
942938348MJC
U003
UT
01
—
Q39422
ICAR
UT
Enumeration date
01/23/2006
Last updated
01/26/2012
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