Provider Demographics
NPI:1063306975
Name:MORTENSEN, ABIGAIL SMITH (RN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:SMITH
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 W 4475 S
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9612
Mailing Address - Country:US
Mailing Address - Phone:385-326-7147
Mailing Address - Fax:
Practice Address - Street 1:3875 STADIUM WAY DEPT 3903
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-3903
Practice Address - Country:US
Practice Address - Phone:385-326-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12456160-3102390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program