Healthcare Provider Details

I. General information

NPI: 1174144927
Provider Name (Legal Business Name): BRIANNA HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 S 900 E
SALT LAKE CITY UT
84117-5735
US

IV. Provider business mailing address

5089 S 900 E STE 201
SALT LAKE CITY UT
84117-5724
US

V. Phone/Fax

Practice location:
  • Phone: 801-288-2229
  • Fax:
Mailing address:
  • Phone: 801-288-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number11725263-3400
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: