Provider Demographics
NPI:1770861510
Name:PUGH, LISA GILLIAM
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GILLIAM
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6324
Mailing Address - Country:US
Mailing Address - Phone:801-427-4160
Mailing Address - Fax:
Practice Address - Street 1:90 E 200 S
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2602
Practice Address - Country:US
Practice Address - Phone:801-427-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife