1073875993 NPI number — MRS. LORETTA MARY FRANCIS MASTER ESTHETICIAN

Table of content: MRS. LORETTA MARY FRANCIS MASTER ESTHETICIAN (NPI 1073875993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073875993 NPI number — MRS. LORETTA MARY FRANCIS MASTER ESTHETICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANCIS
Provider First Name:
LORETTA
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTER ESTHETICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING
Provider Other First Name:
LORETTA
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073875993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3833 SAGE VISTA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR HILLS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84062-8571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-636-6166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6095 S FASHION BLVD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-7397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-213-8351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X , with the licence number:  6777731-1109 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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