Provider Demographics
NPI:1760770762
Name:DEVITT-NIELSEN, BRENDA (RN, MHA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:DEVITT-NIELSEN
Suffix:
Gender:F
Credentials:RN, MHA
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:DEVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:GEORGE E WAHLEN VETERANS ADMINISTRATION CTR
Mailing Address - Street 2:500 FOOTHILL BLVD
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84148-0001
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:
Practice Address - Street 1:GEORGE E WAHLEN VETERANS ADMINISTRATION CTR
Practice Address - Street 2:500 FOOTHILL BLVD
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6182326-3102163WC0400X, 163WP2201X, 163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1100XNursing Service ProvidersRegistered NurseOphthalmic
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care