Provider Demographics
NPI:1609190040
Name:DABB, BRANDON RICHARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:RICHARD
Last Name:DABB
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12734
Mailing Address - Street 2:221 N WASHINGTON BLVD
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84412-2734
Mailing Address - Country:US
Mailing Address - Phone:801-710-6569
Mailing Address - Fax:
Practice Address - Street 1:5674 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9914
Practice Address - Country:US
Practice Address - Phone:801-372-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4918889-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered