Basic Information
| Provider Information | |||||||||
| NPI: | 1740386085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAVER | ||||||||
| FirstName: | LUCY | ||||||||
| MiddleName: | HALL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3702 EAST BRIGHTON PT. DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019446279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 FOOTHILL DRIVE | ||||||||
| Address2: | SALT LAKE VA HOSPITAL, | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015841219 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN 195318-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.