Provider Demographics
NPI:1720442775
Name:BREEN, ANNAMARIE IRENE (NP)
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:IRENE
Last Name:BREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 S 3500 W STE 400
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-6702
Mailing Address - Country:US
Mailing Address - Phone:801-845-4911
Mailing Address - Fax:216-279-8556
Practice Address - Street 1:5991 S 3500 W STE 400
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-6702
Practice Address - Country:US
Practice Address - Phone:801-845-4911
Practice Address - Fax:216-279-8556
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7313401-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner