Healthcare Provider Details

I. General information

NPI: 1730918319
Provider Name (Legal Business Name): DIANE LUCAS DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 S HIGHLAND DR STE 304
HOLLADAY UT
84124-2642
US

IV. Provider business mailing address

4141 S HIGHLAND DR STE 304
HOLLADAY UT
84124-2642
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-0330
  • Fax:
Mailing address:
  • Phone: 801-747-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10495026-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10495026-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: