Individual
BROOKE DAVIS BENINCOSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2891 EVERGREEN PARK DR, HUNTSVILLE, UT 84317-9686
(801) 497-1872
Mailing address
2891 EVERGREEN PARK DR, HUNTSVILLE, UT 84317-9686
(801) 497-1872
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
8145482-3102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8014971872
—
UT
Enumeration date
10/11/2022
Last updated
10/11/2022
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