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NPI Code Detail

MEDICARE: BROOKE LUDWIG

MEDICARE: BROOKE LUDWIG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner8642879-4405UT

General Provider Information

NPI Number : 1134750110
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE LUDWIG
Provider Business Mailing Address
First Line : 280 S MAIN ST
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84010-6236
Country : US
Telephone Number : 801-505-0821
Fax Number :
Provider Business Practice Location Address
First Line : 3435 E PONY EXPRESS PKWY STE 140
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84005-5548
Country : US
Telephone Number : 801-789-2444
Fax Number : 801-789-2045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2020
Last Update Date : 07/20/2022

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