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NPI Code Detail

MEDICARE: BROOKE BAZIL MSN, CRNA

MEDICARE: BROOKE BAZIL MSN, CRNA
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
1163W00000XRegistered Nurse848972CA
2367500000XCertified Registered Nurse Anesthetist95000376CA
3367500000XCertified Registered Nurse Anesthetist7197791UT

General Provider Information

NPI Number : 1447630009
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE BAZIL MSN, CRNA
Provider Business Mailing Address
First Line : 348 W 90 S
Second Line :
City : SALEM
State : UT
Zip : 84653-9158
Country : US
Telephone Number : 801-885-5246
Fax Number :
Provider Business Practice Location Address
First Line : 1900 N STATE ST STE 105
Second Line :
City : PROVO
State : UT
Zip : 84604-1354
Country : US
Telephone Number : 801-655-5245
Fax Number : 801-216-8357
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2015
Last Update Date : 11/11/2022

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