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NPI Code Detail

MEDICARE: MRS. LUANA MAGDALENA NAN PHD

MEDICARE: MRS. LUANA MAGDALENA NAN PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist11353124-2501UT

General Provider Information

NPI Number : 1174746994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LUANA MAGDALENA NAN PHD
Provider Business Mailing Address
First Line : 9477 S LENNOX CIR
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84009-2752
Country : US
Telephone Number : 317-385-9741
Fax Number :
Provider Business Practice Location Address
First Line : 201 S 1460 E RM 426
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84112-9061
Country : US
Telephone Number : 801-581-6826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 01/14/2025

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