Basic Information
Provider Information
NPI: 1003140443
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YURSIK
FirstName: BRENNA
MiddleName: KATHERINE
NamePrefix: DR.
NameSuffix:  
Credential: MD, MPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 15070
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852675070
CountryCode: US
TelephoneNumber: 6028396968
FaxNumber: 6028394144
Practice Location
Address1: 501 N NAVAJO DR
Address2:  
City: PAGE
State: AZ
PostalCode: 860401447
CountryCode: US
TelephoneNumber: 6028396968
FaxNumber: 6028394144
Other Information
ProviderEnumerationDate: 10/01/2009
LastUpdateDate: 02/25/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XR70715AZY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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