Healthcare Provider Details

I. General information

NPI: 1043166887
Provider Name (Legal Business Name): LILY BAUMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEO BAUMES

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E 700 S
SALT LAKE CITY UT
84111-3805
US

IV. Provider business mailing address

131 E 700 S
SALT LAKE CITY UT
84111-3805
US

V. Phone/Fax

Practice location:
  • Phone: 385-707-5692
  • Fax:
Mailing address:
  • Phone: 385-707-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF26-145014
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: