Provider Demographics
NPI:1306902101
Name:LUCEY, RONDA H (NP)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:H
Last Name:LUCEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8661 ALTA COVE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1688
Mailing Address - Country:US
Mailing Address - Phone:801-944-3977
Mailing Address - Fax:801-272-8300
Practice Address - Street 1:1434 E 4500 S
Practice Address - Street 2:SUITE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4250
Practice Address - Country:US
Practice Address - Phone:801-272-6100
Practice Address - Fax:801-272-6101
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT221188-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner