Provider Demographics
NPI:1326519018
Name:OLSEN-LUJAN, TRACI B (APRN/FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:B
Last Name:OLSEN-LUJAN
Suffix:
Gender:F
Credentials:APRN/FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 E WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3564
Mailing Address - Country:US
Mailing Address - Phone:801-448-4654
Mailing Address - Fax:
Practice Address - Street 1:4376 S 700 E STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3077
Practice Address - Country:US
Practice Address - Phone:385-272-4292
Practice Address - Fax:866-855-3582
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373543-4405363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care