Healthcare Provider Details

I. General information

NPI: 1568160281
Provider Name (Legal Business Name): ELIZA BREMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 10TH AVE STE 100
SALT LAKE CITY UT
84103-2870
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-5883
  • Fax:
Mailing address:
  • Phone: 801-397-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11105203-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number11105203-3102
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11105203-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: