Healthcare Provider Details

I. General information

NPI: 1861833303
Provider Name (Legal Business Name): DAPHNE ANNE SOLOMON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAPHNE ANNE SOLOMON DNP

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 1325 N SUITE 300
CEDAR CITY UT
84721-8101
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-865-9500
  • Fax: 435-586-8995
Mailing address:
  • Phone: 435-590-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5129289-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: