Healthcare Provider Details

I. General information

NPI: 1578527909
Provider Name (Legal Business Name): BRETT J ARBON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 2700 N
PLEASANT VIEW UT
84404-4791
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3600
  • Fax: 801-475-3601
Mailing address:
  • Phone: 801-475-3600
  • Fax: 801-475-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5932534-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: