Healthcare Provider Details

I. General information

NPI: 1033512504
Provider Name (Legal Business Name): LUJEAN MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S UNIVERSITY AVE SUITE 3200
PROVO UT
84601-4427
US

IV. Provider business mailing address

151 S UNIVERSITY AVE SUITE 3200
PROVO UT
84601-4427
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-7127
  • Fax: 801-851-7198
Mailing address:
  • Phone: 801-851-7127
  • Fax: 801-851-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: