Basic Information
| Provider Information | |||||||||
| NPI: | 1396493086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEATFILL | ||||||||
| FirstName: | BRETT | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2950 N CHURCH ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840406590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017717771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 E 3900 S STE 3B | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012687725 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2022 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95053192 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 9428409-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.