Healthcare Provider Details

I. General information

NPI: 1679438147
Provider Name (Legal Business Name): LUCIA LAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S 300 E UNIT 413
SALT LAKE CITY UT
84111-1609
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-671-2718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11148829-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: