MEDICARE: LUCY MOWER RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86065136	UT

General Provider Information

NPI Number	:	1770125361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY MOWER RD

Provider Business Mailing Address
First Line	:	3591 S 2000 E
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84109-2946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3591 S 2000 E
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84109-2946
Country	:	US
Telephone Number	:	303-905-8952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	10/15/2019

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Directions to “ LUCY MOWER RD” Practice Location

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