Healthcare Provider Details

I. General information

NPI: 1912494675
Provider Name (Legal Business Name): BRITNEY MARIE PALOMBO DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MAIN ST
PLEASANT GROVE UT
84062-2631
US

IV. Provider business mailing address

110 S MAIN ST
PLEASANT GROVE UT
84062-2631
US

V. Phone/Fax

Practice location:
  • Phone: 801-900-4670
  • Fax: 801-996-7123
Mailing address:
  • Phone: 801-900-4670
  • Fax: 801-996-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7996396-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number7996396-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: