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NPI Code Detail

MEDICARE: BREANNA LUNDQUIST PMHNP

MEDICARE: BREANNA LUNDQUIST PMHNP
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
1163WP0807XChild & Adolescent Psychiatric/Mental Health Registered Nurse9813075-3102UT
2363LP0808XPsychiatric/Mental Health Nurse Practitioner9813075-4405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19813075-8900OTHERUTAPRN CONTROLLED SUBSTANCE SCHEDULE 2-5
22022094133OTHERUTANCC PMHNP-BC
39813075-3102OTHERUTRN LICENSE
4981375-4405OTHERUTAPRN-PMHNP

General Provider Information

NPI Number : 1427660042
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA LUNDQUIST PMHNP
Provider Business Mailing Address
First Line : 45 W SEGO LILY DR STE 312
Second Line :
City : SANDY
State : UT
Zip : 84070-3643
Country : US
Telephone Number : 801-676-9452
Fax Number :
Provider Business Practice Location Address
First Line : 45 W SEGO LILY DR STE 312
Second Line :
City : SANDY
State : UT
Zip : 84070-3643
Country : US
Telephone Number : 801-676-9452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2020
Last Update Date : 02/27/2023

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1366038093 — MRS. AMY BROOKE MORGAN RN
Practice Location Address:
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84070-3643
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Practice Fax: 801-206-9734

Directions to “ BREANNA LUNDQUIST PMHNP” Practice Location

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