Provider Demographics
NPI:1295570059
Name:PIEPER, BROOKE WALTER (APRN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:WALTER
Last Name:PIEPER
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 1:308 E 4500 S STE B
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3957
Mailing Address - Country:US
Mailing Address - Phone:801-900-3280
Mailing Address - Fax:
Practice Address - Street 1:948 S. 190 E.
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759-1235
Practice Address - Country:US
Practice Address - Phone:435-690-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5138621-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care