Provider Demographics
NPI:1700282282
Name:OUTZEN, MARIA ANGELA (MSHED)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELA
Last Name:OUTZEN
Suffix:
Gender:F
Credentials:MSHED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8203
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-8203
Mailing Address - Country:US
Mailing Address - Phone:801-750-4661
Mailing Address - Fax:
Practice Address - Street 1:5880 S ROYALTON DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6559
Practice Address - Country:US
Practice Address - Phone:801-750-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8826019-0160171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter