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Individual
COURTNEY LASUMNER BASS
Active
Individual
COURTNEY LASUMNER BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9321350-3102
UT
363L00000X
Nurse Practitioner
Primary
9321350-4405
UT
Other
Enumeration date
03/16/2022
Last updated
10/20/2024
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