Provider Demographics
NPI:1174746994
Name:NAN, LUANA MAGDALENA (PHD)
Entity type:Individual
Prefix:MRS
First Name:LUANA
Middle Name:MAGDALENA
Last Name:NAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9477 S LENNOX CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-2752
Mailing Address - Country:US
Mailing Address - Phone:317-385-9741
Mailing Address - Fax:
Practice Address - Street 1:201 S 1460 E RM 426
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9061
Practice Address - Country:US
Practice Address - Phone:801-581-6826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11353124-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist