MEDICARE: AMY LEMMON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	4791519-4406	UT

General Provider Information

NPI Number	:	1912398470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEMMON CRNA

Provider Business Mailing Address
First Line	:	1196 E WATERSIDE CV APT 20
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-4288
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1196 E WATERSIDE CV APT 20
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-4288
Country	:	US
Telephone Number	:	801-633-2162
Fax Number	:

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	02/05/2015

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