Provider Demographics
NPI:1346704533
Name:O'BRIEN, BROOKE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 E CANYON CREST DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-8932
Mailing Address - Country:US
Mailing Address - Phone:801-857-0435
Mailing Address - Fax:
Practice Address - Street 1:11762 S STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7158
Practice Address - Country:US
Practice Address - Phone:801-571-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9077556-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily