Healthcare Provider Details

I. General information

NPI: 1083008601
Provider Name (Legal Business Name): MAJA L. LUSK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/26/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 EMERALD OAKS DR
FARMINGTON UT
84025-4108
US

IV. Provider business mailing address

5121 S. COTTONWOOD ST.
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-698-2082
  • Fax:
Mailing address:
  • Phone: 801-507-7673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360092-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number360092-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: