Brogan R Secrist
Student in an Organized Health Care Education/Training Program in Ivins, UT. Individual provider (NPI-1).
NPI number1255083309
StatusActive
Last updated in NPPESJan 20, 2022
Details
- NPI
- 1255083309
- Entity type
- Individual (NPI-1)
- Name
- Brogan R Secrist
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 20, 2022
- Certification date
- Jan 20, 2022
- Last updated
- Jan 20, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
738 S Red Mountain BlvdIvins, UT 84738-1226
Phone 435-705-1644
Mailing address
738 S Red Mountain BlvdIvins, UT 84738-1226
Phone 435-705-1644
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All 17 Student in an Organized Health Care Education/Training Program providers in Ivins · All 79 providers in Ivins
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