Healthcare Provider Details

I. General information

NPI: 1639683287
Provider Name (Legal Business Name): CHERYL LUTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2017
Last Update Date: 11/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 N 180 W
EPHRAIM UT
84627-2130
US

IV. Provider business mailing address

66 N 180 W
EPHRAIM UT
84627-2130
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-0164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1801104054
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: