Healthcare Provider Details

I. General information

NPI: 1609538552
Provider Name (Legal Business Name): RYAN WESTBROEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HARRISON BLVD STE 200
OGDEN UT
84403-2038
US

IV. Provider business mailing address

4126 S 5000 W
WEST HAVEN UT
84401-9403
US

V. Phone/Fax

Practice location:
  • Phone: 801-515-7997
  • Fax: 385-333-7413
Mailing address:
  • Phone: 801-529-8935
  • Fax: 801-627-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ALLISON
Title or Position: BILLING SPECIALIST
Credential:
Phone: 801-391-6617