Courtney Lasumner Bass, NP
Individual provider Active NPI Nurse Practitioner · Midvale, UT
NPI 1871241950 · NPPES record last updated Oct 20, 2024
Key facts
- NPI
- 1871241950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 9321350-4405 (UT)
- Practice address
- 1028 W Rooftop Dr
Midvale, UT 84047-4805 - Phone
- (801) 683-9523
- NPI assigned
- Mar 16, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9321350-3102 | UT | MD | Registered Nurse |
| 9321350-4405 | UT | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 9321350-3102 | UT | |
| Nurse Practitioner | 363L00000X | 9321350-4405 | UT | Yes |
Addresses
Primary practice location
1028 W Rooftop Dr
Midvale, UT 84047-4805
Mailing address
1028 W Rooftop Dr
Midvale, UT 84047-4805
Phone (801) 683-9523
Other providers in Midvale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.