Healthcare Provider Details

I. General information

NPI: 1265072870
Provider Name (Legal Business Name): MR. BRYAN FOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15916 W PORT AU PRINCE LN
SURPRISE AZ
85379-5145
US

IV. Provider business mailing address

15916 W PORT AU PRINCE LN
SURPRISE AZ
85379-5145
US

V. Phone/Fax

Practice location:
  • Phone: 801-822-2029
  • Fax:
Mailing address:
  • Phone: 801-822-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN189755
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number242512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: