Provider Demographics
NPI:1942331244
Name:RAMIREZ, PAUL LUCAS (FNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LUCAS
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 E 12300 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020
Mailing Address - Country:US
Mailing Address - Phone:801-576-1155
Mailing Address - Fax:801-523-2547
Practice Address - Street 1:826 E 12300 S
Practice Address - Street 2:#4
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8276
Practice Address - Country:US
Practice Address - Phone:801-576-1155
Practice Address - Fax:801-523-2547
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747921363L00000X
UT361356-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT361356-4405OtherAPRN
CA564358OtherREGISTERED NURSE
TX747921OtherBOARD OF NURSE EXAMINERS FOR THE STATE OF TEXAS
CA17169OtherNURSE PRACTITIONER