Provider Demographics
NPI:1619411774
Name:BRIGHTERLIFE FAMILY WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:BRIGHTERLIFE FAMILY WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:801-372-5899
Mailing Address - Street 1:471 E 1000 S
Mailing Address - Street 2:STE E
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3693
Mailing Address - Country:US
Mailing Address - Phone:385-233-3350
Mailing Address - Fax:385-233-3354
Practice Address - Street 1:471 E 1000 S
Practice Address - Street 2:STE E
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3693
Practice Address - Country:US
Practice Address - Phone:385-233-3350
Practice Address - Fax:385-233-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT189082-4405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty