Provider Demographics
NPI:1831340389
Name:ROSS, LUCINDA L (APRN)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84091-0932
Mailing Address - Country:US
Mailing Address - Phone:801-746-0776
Mailing Address - Fax:801-553-9562
Practice Address - Street 1:807 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1339
Practice Address - Country:US
Practice Address - Phone:801-746-0776
Practice Address - Fax:801-746-0775
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT202296-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health