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General NPI Number Information
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NPI Number | 1538109715
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Entity Type | Individual
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Provider Name | SANDRA LYNN VANLEUVEN M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 1743 REDSTONE CENTER DR SUITE 115
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City | PARK CITY
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State | UT
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Zip | 84098-7929
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Country | US
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Telephone | 435-658-9200
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Fax | 435-658-9210
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Provider Business Mailing Address
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Address Line | PO BOX 510708
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City | SALT LAKE CITY
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State | UT
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Zip | 84151-0708
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Country | US
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Telephone | 801-213-3900
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Fax | 801-585-3655
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5426490-1205
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License Number State | UT
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