Provider Demographics
NPI:1467040279
Name:UTZAT, BROOKE (PAC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:UTZAT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3565 ROUTE 611 STE 300
Mailing Address - Street 2:
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321-7800
Mailing Address - Country:US
Mailing Address - Phone:484-526-2598
Mailing Address - Fax:866-522-4710
Practice Address - Street 1:3565 ROUTE 611 STE 300
Practice Address - Street 2:
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321-7800
Practice Address - Country:US
Practice Address - Phone:484-526-2598
Practice Address - Fax:866-522-4710
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant