Healthcare Provider Details

I. General information

NPI: 1740944271
Provider Name (Legal Business Name): LIANI ECCLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 RSI DR UNIT 120
LOGAN UT
84321-2203
US

IV. Provider business mailing address

1638 N 200 W
LOGAN UT
84341-1900
US

V. Phone/Fax

Practice location:
  • Phone: 435-512-7825
  • Fax:
Mailing address:
  • Phone: 435-994-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7887916-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: