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General NPI Number Information
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NPI Number | 1154805596
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Entity Type | Individual
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Provider Name | MONICA CONSTANZA BRUNA APRN
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 830 N 2000 W
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-4047
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Country | US
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Telephone | 801-757-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 158 N 590 E
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City | VINEYARD
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State | UT
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Zip | 84059-4834
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Country | US
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Telephone | 801-864-2693
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6396371-4405
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License Number State | UT
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