Healthcare Provider Details

I. General information

NPI: 1306902101
Provider Name (Legal Business Name): RONDA H LUCEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 E 4500 S SUITE 102
SALT LAKE CITY UT
84117-4250
US

IV. Provider business mailing address

8661 ALTA COVE DR
SANDY UT
84093-1688
US

V. Phone/Fax

Practice location:
  • Phone: 801-272-6100
  • Fax: 801-272-6101
Mailing address:
  • Phone: 801-944-3977
  • Fax: 801-272-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number221188-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: