Individual
LUCKY IYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 S MAIN ST STE 500, SALT LAKE CITY, UT 84111-1927
(801) 856-3174
Mailing address
175 S MAIN ST STE 500, SALT LAKE CITY, UT 84111-1927
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
9710753-0151
UT
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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