Individual
LISA MICONI-CORREA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5740 CRESTWOOD DR, OGDEN, UT 84405-4869
(801) 479-7771
(801) 479-7795
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 479-7771
(801) 479-7795
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200854-4408
UT
Other
Enumeration date
07/08/2011
Last updated
01/18/2017
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