Healthcare Provider Details

I. General information

NPI: 1811947708
Provider Name (Legal Business Name): LEON S BROOK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 E RIVERSIDE DR STE 100
ST GEORGE UT
84790-7141
US

IV. Provider business mailing address

2240 E 2540 S
ST GEORGE UT
84790-6540
US

V. Phone/Fax

Practice location:
  • Phone: 435-310-5414
  • Fax:
Mailing address:
  • Phone: 208-241-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRNA428
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number189560-3105
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number227968
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1557
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-428
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP107266
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number189560-8901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: