Breanna Bradley Black, PA-C

NPI #1346972502 in Provo, Utah

Provider Information

NPI Number: 1346972502
Entity Type: Individual
Name: Breanna Bradley Black, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Jun 27, 2022
Last Updated: Oct 3, 2023

Practice Location

Address: 1055 N 500 W BLDG A
City: Provo
State: Utah
ZIP Code: 84604-3305
Phone: (801) 812-5033

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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