Individual
LINDA RICHARDS LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
30 N. 1900 E, SOM 5R218, SALT LAKE CITY, UT 84132-0002
(801) 581-7822
Mailing address
2957 S IDA CIR, SALT LAKE CITY, UT 84106-4034
(801) 722-8359
(801) 585-9166
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10531394-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10531394-1206
DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING- ACTIVE LICENSE
UT
01
—
10531394-8906
DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING- ACTIVE PA-C AND PA-CS LICENSE
UT
Enumeration date
01/22/2018
Last updated
01/22/2018
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