Basic Information
| Provider Information | |||||||||
| NPI: | 1710420617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOFGRAN | ||||||||
| FirstName: | KACIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EGBERT | ||||||||
| OtherFirstName: | KACIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1250 E 3900 S | ||||||||
| Address2: | STE 260 | ||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012652000 | ||||||||
| FaxNumber: | 8012652008 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 E 3900 S STE 260 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012652000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2016 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 6998915-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.