Individual
JASON D BROTHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A,P.R.N.
Contact information
Practice address
1009 W 1560 S, PROVO, UT 84601-5559
(801) 374-9100
Mailing address
1009 W 1560 S, PROVO, UT 84601-5559
(801) 360-4630
Taxonomy
Speciality
Code
Description
License number
State
364SM0705X
Medical-Surgical Clinical Nurse Specialist
308861-4405
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
308861-4406
UT
Other
Enumeration date
11/07/2006
Last updated
02/19/2013
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