Provider Demographics
NPI:1730516220
Name:SCOVILLE, STEPHEN LAMARR (APRN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LAMARR
Last Name:SCOVILLE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1323
Mailing Address - Country:US
Mailing Address - Phone:801-662-9098
Mailing Address - Fax:
Practice Address - Street 1:5788 S WATERBURY WAY
Practice Address - Street 2:UNIT B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1141
Practice Address - Country:US
Practice Address - Phone:801-662-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7427208-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily