Healthcare Provider Details

I. General information

NPI: 1902307853
Provider Name (Legal Business Name): JOHN ROBERT LAGMAN OBRIQUE CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 1200 S
KAYSVILLE UT
84037-2843
US

IV. Provider business mailing address

19 W 1200 S
KAYSVILLE UT
84037-2843
US

V. Phone/Fax

Practice location:
  • Phone: 801-546-8884
  • Fax:
Mailing address:
  • Phone: 801-546-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA036225
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: