Healthcare Provider Details

I. General information

NPI: 1932849908
Provider Name (Legal Business Name): LAUREN MUNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/26/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S 2200 E
SLC UT
84108-3216
US

IV. Provider business mailing address

1840 S 1300 E
SLC UT
84105-3617
US

V. Phone/Fax

Practice location:
  • Phone: 801-674-2556
  • Fax:
Mailing address:
  • Phone: 801-832-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11303047-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: