Provider Demographics
NPI:1831841535
Name:WESTBROEK FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:WESTBROEK FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-391-6617
Mailing Address - Street 1:4126 S 5000 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9403
Mailing Address - Country:US
Mailing Address - Phone:801-515-7997
Mailing Address - Fax:385-333-7413
Practice Address - Street 1:475 40TH ST STE 111
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1856
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:385-333-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty