MEDICARE: MRS. JENNIFER JAY LUI CEO

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
1	374U00000X	Home Health Aide	UT000283580699	UT

General Provider Information

NPI Number	:	1619682960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JAY LUI CEO

Provider Business Mailing Address
First Line	:	PO BOX 271
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84089-0271
Country	:	US
Telephone Number	:	801-759-8975
Fax Number	:

Provider Business Practice Location Address
First Line	:	3197 W 650 N
Second Line	:
City	:	WEST POINT
State	:	UT
Zip	:	84015-6809
Country	:	US
Telephone Number	:	801-759-8975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	09/08/2023

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