Healthcare Provider Details

I. General information

NPI: 1104782119
Provider Name (Legal Business Name): LUME HEALTH ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 N MAIN ST
CLEARFIELD UT
84015-2551
US

IV. Provider business mailing address

69 N MAIN ST
CLEARFIELD UT
84015-2551
US

V. Phone/Fax

Practice location:
  • Phone: 385-231-8388
  • Fax:
Mailing address:
  • Phone: 385-231-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRACE A OSINDERO
Title or Position: MANAGER
Credential:
Phone: 385-231-8388