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COURTNEY LASUMNER BASS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
1028 W ROOFTOP DR, MIDVALE, UT 84047-4805
(801) 683-9523
Mailing address
1028 W ROOFTOP DR, MIDVALE, UT 84047-4805
(801) 683-9523

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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