Provider Demographics
NPI:1023313020
Name:RIZZUTO, BREAWN (NP-C)
Entity type:Individual
Prefix:
First Name:BREAWN
Middle Name:
Last Name:RIZZUTO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-284-1702
Mailing Address - Fax:801-262-3897
Practice Address - Street 1:5323 WOODROW ST
Practice Address - Street 2:SUITE #102
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5841
Practice Address - Country:US
Practice Address - Phone:801-913-1010
Practice Address - Fax:801-913-0665
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5648845-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner