Healthcare Provider Details

I. General information

NPI: 1184901068
Provider Name (Legal Business Name): BROOKE ANN WELSH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ANN WEBER WHNP

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 12/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W STE 212
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-812-5033
  • Fax: 801-812-5034
Mailing address:
  • Phone: 801-812-5033
  • Fax: 801-812-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5262019-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: