Healthcare Provider Details

I. General information

NPI: 1720722366
Provider Name (Legal Business Name): ANNALIE BRENNAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 S MEDICAL CENTER DR STE 110
ST GEORGE UT
84790-7077
US

IV. Provider business mailing address

652 S MEDICAL CENTER DR STE 110
ST GEORGE UT
84790-7077
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-3600
  • Fax:
Mailing address:
  • Phone: 352-513-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108366674405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: