Healthcare Provider Details

I. General information

NPI: 1053256347
Provider Name (Legal Business Name): LORI FISK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E BRUSH CREEK RD
JENSEN UT
84035-7703
US

IV. Provider business mailing address

PO BOX 48
JENSEN UT
84035-0048
US

V. Phone/Fax

Practice location:
  • Phone: 435-828-5674
  • Fax:
Mailing address:
  • Phone: 435-828-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4972140-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: