Healthcare Provider Details

I. General information

NPI: 1780511444
Provider Name (Legal Business Name): BROOKE LANE MILLER BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD
OGDEN UT
84403-3271
US

IV. Provider business mailing address

5483 DAY LILY DR
MORGAN UT
84050-9265
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-6405
  • Fax:
Mailing address:
  • Phone: 801-668-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number309079-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: