Healthcare Provider Details

I. General information

NPI: 1770631079
Provider Name (Legal Business Name): LINDA YOUNG LEWIS FNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR STE 3400
SLC UT
84113-1103
US

IV. Provider business mailing address

100 N MEDICAL DR STE 3400
SLC UT
84113-1103
US

V. Phone/Fax

Practice location:
  • Phone: 801-588-3650
  • Fax:
Mailing address:
  • Phone: 801-588-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203089-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: