Basic Information
| Provider Information | |||||||||
| NPI: | 1548881097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLUKEY | ||||||||
| FirstName: | DAYSHA | ||||||||
| MiddleName: | ALAYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7559 STAGECOACH DR | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840985333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358902275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 440 S 500 E | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841022705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013598862 | ||||||||
| FaxNumber: | 8013598510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2020 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 11615009-3103 | UT | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.