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Individual

MARCIA KAY LIDTKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-9656
(801) 373-2978
Mailing address
23 E EMERALD CT, SARATOGA SPRINGS, UT 84045-8141
(408) 813-0780

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
13626
CA
363LF0000X
Family Nurse Practitioner
Primary
9836853-4405
UT

Other

Enumeration date
05/08/2007
Last updated
01/19/2017
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