Healthcare Provider Details

I. General information

NPI: 1205524923
Provider Name (Legal Business Name): MISS BRIANNA NGUYEN LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S TOOELE BLVD
TOOELE UT
84074-2093
US

IV. Provider business mailing address

2293 W AUGUST FARMS CIR
WEST VALLEY CITY UT
84119-6044
US

V. Phone/Fax

Practice location:
  • Phone: 435-248-0333
  • Fax:
Mailing address:
  • Phone: 801-783-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14242992-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: