Individual
BREANNA LUNDQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
45 W SEGO LILY DR STE 312, SANDY, UT 84070-3643
(801) 676-9452
Mailing address
45 W SEGO LILY DR STE 312, SANDY, UT 84070-3643
(801) 676-9452
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
9813075-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9813075-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022094133
ANCC PMHNP-BC
UT
01
—
9813075-3102
RN LICENSE
UT
01
—
9813075-8900
APRN CONTROLLED SUBSTANCE SCHEDULE 2-5
UT
01
—
981375-4405
APRN-PMHNP
UT
Enumeration date
08/17/2020
Last updated
02/27/2023
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