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General NPI Number Information
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NPI Number | 1578752614
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Entity Type | Individual
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Provider Name | BRENNA W. BECKER NP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 675 S ARAPEEN DR # DR205
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1223
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Country | US
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Telephone | 801-581-3834
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Fax |
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Provider Business Mailing Address
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Address Line | 2738 E PEBBLE GLEN CIR
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-3047
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Country | US
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Telephone | 508-864-5012
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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 | RN266912
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9811085-4405
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License Number State | UT
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