Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 8311379-4405 | UT |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN002314 | NV |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 8311379-4405 | UT |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN002314 | NV |
NPI | 1003267923 |
---|---|
Provider Name | Mr. Brooks Wiley |
First Address | St George, UT 84790-2584 |
Second Address | St George, UT 84790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 29/05/2018 |