Provider Demographics
NPI:1558687236
Name:WATERHOUSE, LU LU (MD)
Entity Type:Individual
Prefix:DR
First Name:LU
Middle Name:LU
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LU
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7138 S 2000 E
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3757
Mailing Address - Country:US
Mailing Address - Phone:801-942-1800
Mailing Address - Fax:801-944-1865
Practice Address - Street 1:7138 S 2000 E
Practice Address - Street 2:SUITE 106
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3757
Practice Address - Country:US
Practice Address - Phone:801-942-1800
Practice Address - Fax:801-944-1865
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8159261-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics