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General NPI Number Information
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NPI Number | 1003779794
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Entity Type | Individual
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Provider Name | MIRANDA MARY BRENNAN
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-3195
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Country | US
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Telephone | 385-405-6058
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 N 4800 W
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City | PLAIN CITY
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State | UT
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Zip | 84404-9248
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Country | US
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Telephone | 385-405-6058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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