Provider Demographics
NPI:1811947708
Name:BROOK, LEON S (CRNA)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:S
Last Name:BROOK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E 2540 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6540
Mailing Address - Country:US
Mailing Address - Phone:208-241-0591
Mailing Address - Fax:
Practice Address - Street 1:585 E RIVERSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7141
Practice Address - Country:US
Practice Address - Phone:435-310-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA428163W00000X
UT189560-3105163W00000X
CT227968367500000X
AZCRNA1557367500000X
IDRNA-428367500000X
TXAP107266367500000X
UT189560-8901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805525600Medicare ID - Type Unspecified
ID1602891Medicare ID - Type Unspecified