Healthcare Provider Details

I. General information

NPI: 1326473885
Provider Name (Legal Business Name): CLIPHANE BROUGH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DRIVE
SALT LAKE CITY UT
84132
US

IV. Provider business mailing address

890 E 4170 S
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7822
  • Fax:
Mailing address:
  • Phone: 801-414-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282999-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: