MARCIA KAY LIDTKE (NPI# 1972716496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972716496 |
| Entity Type | Individual |
| Full Name | MARCIA KAY LIDTKE |
| Credential | FNP-C |
| Practice Address |
750 N Freedom Blvd Provo UT 84601-1677 |
| Mailing Address |
23 E Emerald Ct Saratoga Springs UT 84045-8141 |
| Practice Telephone | 8013739656 |
| Practice Fax Number | 8013732978 |
| Mailing Telephone | 4088130780 |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2017-01-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
13626 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
9836853-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
750 N FREEDOM BLVD |
| City | PROVO |
| State | UT |
| Zip Code | 84601-1677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679551634 | Amy Buehler | Social Worker | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2006-01-09 |
| 1437750270 | Michael Stevenson | Case Manager/Care Coordinator | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-11-06 |
| 1174122683 | Alyssa Ketler | Case Manager/Care Coordinator | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-26 |
| 1770183261 | Kaitlin Buckway | Case Manager/Care Coordinator | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-26 |
| 1841899465 | Linda Madsen Fifita | Student in an Organized Health Care Education/Training Program | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-23 |
| 1427657352 | Jessica Ray Clyde | Licensed Practical Nurse | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-21 |
| 1134728033 | Tyra Tsosie | Student in an Organized Health Care Education/Training Program | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-21 |
| 1457950529 | Justin Jacobson | Student in an Organized Health Care Education/Training Program | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-20 |
| 1881293264 | Kurt Louis Candalot | Case Manager/Care Coordinator | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-18 |
| 1265030613 | Ailaina Nicole Herman Rice | Student in an Organized Health Care Education/Training Program | 750 N Freedom Blvd, Provo, UT 84601-1677 | 2020-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902378417 | 1 Assist Care of Utah Valley LLC | In Home Supportive Care | 180 N University Avenue, Suite 270, Office 213, Provo, UT 84601 | 2018-12-21 |
| 1346723319 | Mp Dental LLC | Dentist | 777 N. 500 W. #204, Proud, UT 84601 | 2018-09-14 |
| 1326530601 | Madison Paige Nelson | Case Manager/Care Coordinator | 750 N Freedom Blvd., Provo, UT 84601 | 2018-06-03 |
| 1245758861 | Annette Roylance | Case Manager/Care Coordinator | 750 North Freedom Boulevard, Suite 300, Provo, UT 84601 | 2017-09-04 |
| 1912422205 | Alexandra Mcbride | Specialist/Technologist | 35 N 300 W #440, Provo, UT 84601 | 2017-08-07 |
| 1932638293 | Audrey Clara Clifton | Case Manager/Care Coordinator | 750 North Freedom Blvd., Provo, UT 84601 | 2017-06-08 |
| 1528514197 | Joseph Hyrum Lewis | Case Manager/Care Coordinator | 750 Freedom Blvd, Provo, UT 84601 | 2016-09-01 |
| 1629427620 | Walker Clements | Case Manager/Care Coordinator | 750 North Freedom Blvd, Provo, UT 84601 | 2016-06-09 |
| 1447611595 | Robert Shirley | Student in an Organized Health Care Education/Training Program | 750 North 200 West, Provo, Ut 84601., Provo, UT 84601 | 2016-03-17 |
| 1700286283 | Brelynn Downs | Student in an Organized Health Care Education/Training Program | 750 North Freedom Blvde, Provo, UT 84601 | 2014-09-03 |
| Find all providers in zip 84601 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750998860 | Jeremy Llewellyn | Nurse Practitioner | 395 W Cougar Blvd Fl 5, Provo, UT 84604-3323 | 2020-09-24 |
| 1336765882 | Julie Andrea Rogers | Nurse Practitioner | 428 W 4620 N, Provo, UT 84604-5537 | 2020-06-21 |
| 1992337208 | Xiao Xiao Zou Hoffman | Nurse Practitioner | 1747 N 1500 W, Provo, UT 84604-1146 | 2020-02-05 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1174095855 | Jared Hawkins | Nurse Practitioner | 1034 N 500 W # 84604, Provo, UT 84604-3380 | 2018-12-19 |
| 1891270062 | Catherine Leilani Barrus | Nurse Practitioner | 2833 Indian Hills Cir, Provo, UT 84604-4333 | 2018-10-03 |
| 1760968804 | Amanda Graves | Nurse Practitioner | 1900 N State St Ste 103, Provo, UT 84604-1354 | 2018-07-12 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1205356250 | Gordon Dale Mills Jr. | Nurse Practitioner | 1055 N 500 W # 212, Provo, UT 84604-3305 | 2017-06-21 |
| 1770034845 | Megan Mackenzie Zitting | Nurse Practitioner | 1437 E 1270 S, Provo, UT 84606-6527 | 2016-10-24 |
| Find all providers in PROVO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.