Provider Demographics
NPI:1619179140
Name:MULVIHILL, LYNN MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:MULVIHILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 E MEADOW LARK WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2644
Mailing Address - Country:US
Mailing Address - Phone:517-410-5719
Mailing Address - Fax:
Practice Address - Street 1:4465 S 900 E
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2469
Practice Address - Country:US
Practice Address - Phone:801-266-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8415704-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical