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General NPI Number Information
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NPI Number | 1407028590
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Entity Type | Organization
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Legal Business Name | BRIAN DELL GASSER NP LLC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 772 E 100 N SUITE #6
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City | PAYSON
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State | UT
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Zip | 84651-2345
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Country | US
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Telephone | 801-376-2052
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Fax | 801-465-6161
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Provider Business Mailing Address
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Address Line | 772 E 100 N SUITE #6
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City | PAYSON
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State | UT
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Zip | 84651-2345
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Country | US
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Telephone | 801-376-2052
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Fax | 801-465-6161
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Authorized Official
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Title or Position | OWNER NURSE PRACTITIONER
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Name | MR. BRIAN DELL GASSER
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Credential | APRN BC
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Telephone | 801-376-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2072864405
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License Number State | UT
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