MEDICARE: MRS. JOANN MARIE BRAMMER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4747751-3102	UT

General Provider Information

NPI Number	:	1124098017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANN MARIE BRAMMER RN

Provider Business Mailing Address
First Line	:	5965 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1720
Country	:	US
Telephone Number	:	801-263-7138
Fax Number	:

Provider Business Practice Location Address
First Line	:	5965 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1720
Country	:	US
Telephone Number	:	801-263-7138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/19/2015

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