Provider Demographics
NPI:1942784335
Name:DUKE, HEATHER LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:DUKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12582 S FORT ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9447
Mailing Address - Country:US
Mailing Address - Phone:801-662-8610
Mailing Address - Fax:
Practice Address - Street 1:12582 S FORT ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9447
Practice Address - Country:US
Practice Address - Phone:801-662-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7644034-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist