Healthcare Provider Details

I. General information

NPI: 1952126500
Provider Name (Legal Business Name): LINDSAY SUNDLOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 N 7 C LN
ERDA UT
84074-7432
US

IV. Provider business mailing address

4482 N 7 C LN
ERDA UT
84074-7432
US

V. Phone/Fax

Practice location:
  • Phone: 435-241-0037
  • Fax:
Mailing address:
  • Phone: 435-241-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number11762094-3103
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: