Provider Demographics
NPI:1578311882
Name:LAU, JARICKA BLUNDELL (APRN)
Entity type:Individual
Prefix:
First Name:JARICKA
Middle Name:BLUNDELL
Last Name:LAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JARICKA
Other - Middle Name:NICOLE
Other - Last Name:ASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12760 S PARK AVE UNIT 216
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3409
Mailing Address - Country:US
Mailing Address - Phone:801-598-9812
Mailing Address - Fax:888-256-5101
Practice Address - Street 1:12760 S PARK AVE UNIT 216
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-3409
Practice Address - Country:US
Practice Address - Phone:801-598-9812
Practice Address - Fax:888-256-5101
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7643431-3102163W00000X
UT7643431-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse