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NPI Code Detail

MEDICARE: MS. BRENDA DEVITT-NIELSEN RN, MHA

MEDICARE: MS. BRENDA DEVITT-NIELSEN RN, MHA
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
1163WC0400XCase Management Registered Nurse6182326-3102UT
2163WP2201XAmbulatory Care Registered Nurse6182326-3102UT
3163WX1100XOphthalmic Registered Nurse6182326-3102UT

General Provider Information

NPI Number : 1760770762
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRENDA DEVITT-NIELSEN RN, MHA
Provider Business Mailing Address
First Line : GEORGE E WAHLEN VETERANS ADMINISTRATION CTR
Second Line : 500 FOOTHILL BLVD
City : SALT LAKE CITY
State : UT
Zip : 84148-0001
Country : US
Telephone Number : 801-582-1565
Fax Number :
Provider Business Practice Location Address
First Line : GEORGE E WAHLEN VETERANS ADMINISTRATION CTR
Second Line : 500 FOOTHILL BLVD
City : SALT LAKE CITY
State : UT
Zip : 84148-0001
Country : US
Telephone Number : 801-582-1565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2011
Last Update Date : 07/12/2011

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