Provider Demographics
NPI:1447630009
Name:BAZIL, BROOKE (MSN, CRNA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BAZIL
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:KATIE
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:348 W 90 S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9158
Mailing Address - Country:US
Mailing Address - Phone:801-885-5246
Mailing Address - Fax:
Practice Address - Street 1:1900 N STATE ST STE 105
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1354
Practice Address - Country:US
Practice Address - Phone:801-655-5245
Practice Address - Fax:801-216-8357
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA848972163W00000X
CA95000376367500000X
UT7197791367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse