Individual
VICKY SURUKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
(888) 676-7104
Mailing address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
8792215-3102
UT
363LF0000X
Family Nurse Practitioner
Primary
8792215-4405
UT
Other
Enumeration date
10/23/2019
Last updated
08/29/2023
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