Individual
BRANDON S HERMANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1433 N 1075 W STE 104, FARMINGTON, UT 84025-2746
(801) 298-1300
(801) 296-6199
Mailing address
PO BOX 25488, SALT LAKE CITY, UT 84125-0488
(800) 475-3698
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6711038-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143659
PEHP
UT
01
—
964305
WINDSOR HEALTH PLAN MEDICAREEXTRA/STERLING HEALTH PLAN
UT
01
—
P01132445
RAILROAD MEDICARE
UT
Enumeration date
09/18/2012
Last updated
02/26/2019
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