| Doctor Name: | DR. BRIANNA LASTRE |
| NPI Number: | 1194157123 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, WHNP, CNM |
| License Number: | 7247318-4405 |
| Business Practice Address: | 1446 W Pleasant Grove Blvd. Pleasant Grove, UT - 84062 |
| Business Phone Number: | 8017855100 |
| Business Fax Number: | |
| Mailing Address: | 1446 W Pleasant Grove Blvd., PLEASANT GROVE |
| State: | UT |
| Postal Code: | 84062 |
| Phone Number: | 8017855100 |
| Fax Number: | |
| NPI Enumeration Date: | 08/01/2013 |
| NPI Last Update Date: | 08/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 7247318-4405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |