Provider Demographics
NPI:1710918586
Name:LLOYD, MARLIESE LOVELEI (PAC)
Entity Type:Individual
Prefix:
First Name:MARLIESE
Middle Name:LOVELEI
Last Name:LLOYD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 SUNNY PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118
Mailing Address - Country:US
Mailing Address - Phone:801-502-4222
Mailing Address - Fax:
Practice Address - Street 1:8211 W 3500 SO
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:801-250-3204
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60858481206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant