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BREANNA NICOLE LUNDQUIST
Psychiatric/Mental Health, Child & Adolescent >> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1427660042
Individual Registrant: BREANNA NICOLE LUNDQUIST
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
15254 S CAVALRY CT BLUFFDALE, UT 84065-4992 US
Tel: 801-455-9606 Fax: --
Tel: 801-455-9606 Fax: --
Contact information for business:
15254 S CAVALRY CT BLUFFDALE, UT 84065-4992 US
Tel: 801-455-9606 Fax: --
Tel: 801-455-9606 Fax: --
Registration Information:
NPI: 1427660042
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 163WP0807X | Nursing Service Providers Registered Nurse Psychiatric/Mental Health, Child & Adolescent | UT | 9813075-3102 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| RN LICENSE | 9813075-3102 | UT | 01 |
