Healthcare Provider Details

I. General information

NPI: 1477833382
Provider Name (Legal Business Name): ALISSA LAI-MING FIRMAGE APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S 400 W
SALT LAKE CITY UT
84101-2201
US

IV. Provider business mailing address

404 S 400 W
SALT LAKE CITY UT
84101-2201
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-0058
  • Fax: 801-364-0161
Mailing address:
  • Phone: 801-364-0058
  • Fax: 801-364-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7968617-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: