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General NPI Number Information
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NPI Number | 1720883564
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Entity Type | Individual
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Provider Name | BRET G STOLL PMHNP
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Gender | Male
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1333 S VALLEY GROVE WAY
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6763
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Country | US
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Telephone | 801-683-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 342 E ZION TRL S
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City | TOQUERVILLE
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State | UT
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Zip | 84774-5123
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Country | US
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Telephone | 503-780-3583
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12142486-4405
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License Number State | UT
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