Healthcare Provider Details

I. General information

NPI: 1124912332
Provider Name (Legal Business Name): BROOKE CHILD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W 1360 N
TOOELE UT
84074-1892
US

IV. Provider business mailing address

526 W 1360 N
TOOELE UT
84074-1892
US

V. Phone/Fax

Practice location:
  • Phone: 801-631-0720
  • Fax:
Mailing address:
  • Phone: 801-631-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10968099-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: