Provider Demographics
NPI:1699967919
Name:CROOKSTON, LAURIE DEE (RN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:DEE
Last Name:CROOKSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:DEE
Other - Last Name:CROOKSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:438 E MUTTON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1229
Mailing Address - Country:US
Mailing Address - Phone:801-546-0733
Mailing Address - Fax:
Practice Address - Street 1:1225 FORT UNION BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-1889
Practice Address - Country:US
Practice Address - Phone:801-233-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201679-3102163W00000X
UT201679-4408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse