Provider Demographics
NPI:1629210646
Name:BRADY, LIENA M (APRN)
Entity Type:Individual
Prefix:
First Name:LIENA
Middle Name:M
Last Name:BRADY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E 7000 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6894
Mailing Address - Country:US
Mailing Address - Phone:801-256-0009
Mailing Address - Fax:
Practice Address - Street 1:926 W 1700 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-8530
Practice Address - Country:US
Practice Address - Phone:801-614-2100
Practice Address - Fax:801-614-2101
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292983-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily