Healthcare Provider Details

I. General information

NPI: 1508246844
Provider Name (Legal Business Name): BROOK VIETOR APRN., FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR ROOM AC147
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

3607 E SUPERNAL CIR
COTTONWOOD HEIGHTS UT
84121-6022
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2222
  • Fax:
Mailing address:
  • Phone: 210-379-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8849242-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: