Healthcare Provider Details

I. General information

NPI: 1801130042
Provider Name (Legal Business Name): PUI SEE JENNY YEUNG DIEHL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2012
Last Update Date: 11/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E MAIN ST
LEHI UT
84043-2288
US

IV. Provider business mailing address

127 E MAIN ST
LEHI UT
84043-2288
US

V. Phone/Fax

Practice location:
  • Phone: 801-766-9822
  • Fax:
Mailing address:
  • Phone: 801-766-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6444085-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: