Provider Demographics
NPI:1720883564
Name:STOLL, BRET G (RN)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:G
Last Name:STOLL
Suffix:
Gender:
Credentials:RN
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Other - Middle Name:
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Mailing Address - Street 1:342 E ZION TRL S
Mailing Address - Street 2:
Mailing Address - City:TOQUERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84774-5123
Mailing Address - Country:US
Mailing Address - Phone:503-780-3583
Mailing Address - Fax:
Practice Address - Street 1:5965 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1850
Practice Address - Country:US
Practice Address - Phone:801-639-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT12142486-31022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry