Healthcare Provider Details

I. General information

NPI: 1740797257
Provider Name (Legal Business Name): LISSA ANNE HUTCHINGS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 3900 S STE 3G
SALT LAKE CITY UT
84124-1326
US

IV. Provider business mailing address

2531 S 7025 W
WEST VALLEY UT
84128-5523
US

V. Phone/Fax

Practice location:
  • Phone: 801-346-7788
  • Fax: 801-650-7788
Mailing address:
  • Phone: 801-558-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6915000-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: