Individual
BROOKE ELIZABETH LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MMS, PA-C
Contact information
Practice address
10290 N NORTH COUNTY BLVD STE 200, HIGHLAND, UT 84003-8973
(801) 899-3391
Mailing address
10290 N NORTH COUNTY BLVD STE 200, HIGHLAND, UT 84003-8973
(801) 899-3391
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
12304844-1206
UT
Other
Enumeration date
10/16/2019
Last updated
12/08/2021
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