MEDICARE: LIENA M BRADY APRN

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	363LF0000X	Family Nurse Practitioner	292983-4405	UT

General Provider Information

NPI Number	:	1629210646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIENA M BRADY APRN

Provider Business Mailing Address
First Line	:	1950 E 7000 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6894
Country	:	US
Telephone Number	:	801-256-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 W 1700 S
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-8530
Country	:	US
Telephone Number	:	801-614-2100
Fax Number	:	801-614-2101

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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Directions to “ LIENA M BRADY APRN” Practice Location

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