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General NPI Number Information
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NPI Number | 1033627351
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Entity Type | Individual
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Provider Name | LINDA RICHARDS LEWIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 30 N. 1900 E SOM 5R218
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0002
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Country | US
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Telephone | 801-581-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 2957 S IDA CIR
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-4034
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Country | US
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Telephone | 801-722-8359
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Fax | 801-585-9166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10531394-1206
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License Number State | UT
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