Provider Demographics
NPI:1780144626
Name:EVERETT, ANNA RUTH (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:RUTH
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2295 S FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4000
Mailing Address - Country:US
Mailing Address - Phone:801-486-3021
Mailing Address - Fax:801-485-6339
Practice Address - Street 1:2295 S FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-4000
Practice Address - Country:US
Practice Address - Phone:801-486-3021
Practice Address - Fax:801-485-6339
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT11102959-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant