Provider Demographics
NPI:1184901068
Name:WELSH, BROOKE ANN (WHNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:WELSH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ANN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-812-5033
Mailing Address - Fax:801-812-5033
Practice Address - Street 1:1055 N 500 W
Practice Address - Street 2:STE 212
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-812-5033
Practice Address - Fax:801-812-5034
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5262019-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health