MEDICARE: GRETCHEN DENNISON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5225389-4405	UT
2	363L00000X	Nurse Practitioner	5225389-4405	UT

General Provider Information

NPI Number	:	1801335005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN DENNISON FNP-C

Provider Business Mailing Address
First Line	:	3511 E BENGAL BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5901
Country	:	US
Telephone Number	:	801-712-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 E BENGAL BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5901
Country	:	US
Telephone Number	:	801-712-3692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	09/05/2025

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