Individual
LARA COOLEY PORTMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
8TH AVE C ST, SALT LAKE CITY, UT 84143-0001
(801) 408-1100
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 408-1100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4942578-4405
UT
Other
Enumeration date
12/29/2006
Last updated
03/18/2008
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