BREANNA BRADLEY BLACK

PROVO, UT
NPI1346972502
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: UT  13603008-1206)
Enumeration Date2022-06-27
Last Update Date2023-10-03
Business Address
BREANNA BRADLEY BLACK PA-C
1055 N 500 W BLDG A
PROVO, UT 84604-3305
Phone number: 801-812-5033
Mailing Address
BREANNA BRADLEY BLACK PA-C
1055 N 500 W ATTN CREDENTIALING
PROVO, UT 84604-3305
Phone number: 801-354-8225
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