Provider Demographics
NPI:1750895538
Name:SILCOX, CHANNING BREANA (RN)
Entity type:Individual
Prefix:
First Name:CHANNING
Middle Name:BREANA
Last Name:SILCOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHANNING
Other - Middle Name:BREANA
Other - Last Name:EGLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4856 W LEGACY SPRINGS DR APT 907
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4856 W LEGACY SPRINGS DR APT 907
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7385
Practice Address - Country:US
Practice Address - Phone:801-253-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9031978-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health