Healthcare Provider Details

I. General information

NPI: 1578311882
Provider Name (Legal Business Name): JARICKA BLUNDELL LAU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JARICKA NICOLE ASH RN

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 S PARK AVE UNIT 216
RIVERTON UT
84065-3409
US

IV. Provider business mailing address

6975 S UNION PARK CTR STE 675
COTTONWOOD HEIGHTS UT
84047-6048
US

V. Phone/Fax

Practice location:
  • Phone: 801-598-9812
  • Fax: 888-256-5101
Mailing address:
  • Phone: 385-458-3915
  • Fax: 888-256-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7643431-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7643431-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: