Provider Demographics
NPI:1407028590
Name:BRIAN DELL GASSER NP LLC
Entity Type:Organization
Organization Name:BRIAN DELL GASSER NP LLC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DELL
Authorized Official - Last Name:GASSER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN BC
Authorized Official - Phone:801-376-2052
Mailing Address - Street 1:772 E 100 N
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2345
Mailing Address - Country:US
Mailing Address - Phone:801-376-2052
Mailing Address - Fax:801-465-6161
Practice Address - Street 1:772 E 100 N
Practice Address - Street 2:SUITE #6
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2345
Practice Address - Country:US
Practice Address - Phone:801-376-2052
Practice Address - Fax:801-465-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2072864405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058057Medicare PIN