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: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E 3900 S
SALT LAKE CITY UT
84124-1300
US

IV. Provider business mailing address

PO BOX 741648
ATLANTA GA
30374-1648
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-7111
  • Fax:
Mailing address:
  • Phone:
  • 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: