Individual
BRYANT LEWIS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8TH AVE C STREET, SALT LAKE CITY, UT 84143-0001
(801) 408-3350
(770) 701-6675
Mailing address
PO BOX 3570, SALT LAKE CITY, UT 84110-3570
(801) 432-2600
(770) 701-6675
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N37726
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
5252922-4406
UT
367500000X
Certified Registered Nurse Anesthetist
RNA-717
ID
Other
Enumeration date
03/18/2008
Last updated
10/19/2022
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