Individual
LAURA BROOKE-ELLISON LOCKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPAS
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-7818
Mailing address
8812 S BLUE JAY LN, COTTONWOOD HEIGHTS, UT 84121-6109
(801) 301-1790
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10078763-1206
UT
Other
Enumeration date
08/22/2016
Last updated
01/12/2018
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