Healthcare Provider Details

I. General information

NPI: 1255061347
Provider Name (Legal Business Name): LAUREN REYNOLDS DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W CANYON CREST RD STE 200
ALPINE UT
84004-1966
US

IV. Provider business mailing address

1098 W EARLY LIGHT WAY
BLUFFDALE UT
84065-1880
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-9851
  • Fax:
Mailing address:
  • Phone: 801-310-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number11760834-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11760834-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: