Provider Demographics
NPI:1316783129
Name:CUELLAR, LORRAINE BRIDGET (RN)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:BRIDGET
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 W 8090 S APT B308
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5950
Mailing Address - Country:US
Mailing Address - Phone:310-497-5294
Mailing Address - Fax:
Practice Address - Street 1:8265 W 2700 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1323
Practice Address - Country:US
Practice Address - Phone:310-497-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9145002-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse