Healthcare Provider Details

I. General information

NPI: 1023313020
Provider Name (Legal Business Name): BREAWN RIZZUTO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 WOODROW ST SUITE #102
MURRAY UT
84107-5841
US

IV. Provider business mailing address

5444 GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-913-1010
  • Fax: 801-913-0665
Mailing address:
  • Phone: 801-284-1702
  • Fax: 801-262-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5648845-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: