MEDICARE: LIVE LOVE DREAM WELLNESS

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1942826920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE LOVE DREAM WELLNESS

Provider Business Mailing Address
First Line	:	9735 S 2950 W
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3262
Country	:	US
Telephone Number	:	801-631-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	9735 S 2950 W
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-3262
Country	:	US
Telephone Number	:	801-631-2299
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ASHLEY LYNN CONDIE
Credential	:	PHARMD
Telephone Number	:	801-631-2299

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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Directions to “LIVE LOVE DREAM WELLNESS ” Practice Location

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