Provider Demographics
NPI:1942831557
Name:LEE, BRYANNA J (DEM)
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9674
Mailing Address - Country:US
Mailing Address - Phone:385-225-0074
Mailing Address - Fax:435-578-0720
Practice Address - Street 1:453 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1654
Practice Address - Country:US
Practice Address - Phone:435-249-7292
Practice Address - Fax:435-578-0720
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife