Provider Demographics
NPI:1528290848
Name:BROWN, NANCY CRANDELL (PNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CRANDELL
Last Name:BROWN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:BROWN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:100 NORTH MARIO CAPPECHI DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113
Mailing Address - Country:US
Mailing Address - Phone:801-662-2840
Mailing Address - Fax:801-662-2868
Practice Address - Street 1:100 NORTH MARIO CAPPECHI DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113
Practice Address - Country:US
Practice Address - Phone:801-662-2840
Practice Address - Fax:801-662-2840
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT208246-4409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner