Provider Demographics
NPI:1992324206
Name:ANEW CLINICAL PRACTITIONERS PLLC
Entity type:Organization
Organization Name:ANEW CLINICAL PRACTITIONERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROADHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-654-3229
Mailing Address - Street 1:11762 S STATE ST STE 160
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7174
Mailing Address - Country:US
Mailing Address - Phone:801-654-3229
Mailing Address - Fax:
Practice Address - Street 1:11762 S STATE ST STE 160
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7174
Practice Address - Country:US
Practice Address - Phone:801-654-3229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty