Healthcare Provider Details

I. General information

NPI: 1407421936
Provider Name (Legal Business Name): LILLIAN TOWNSEND NORTON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6393 W 4600 S
HOOPER UT
84315-6753
US

IV. Provider business mailing address

6393 W 4600 S
HOOPER UT
84315-6753
US

V. Phone/Fax

Practice location:
  • Phone: 404-725-1009
  • Fax:
Mailing address:
  • Phone: 404-725-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberUT011758901016
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: