Healthcare Provider Details

I. General information

NPI: 1619814845
Provider Name (Legal Business Name): NICOLE DYER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14658 S BANGERTER PKWY STE 100
DRAPER UT
84020-5022
US

IV. Provider business mailing address

1043 S 750 W
SALEM UT
84653-6510
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-0826
  • Fax:
Mailing address:
  • Phone: 801-589-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10186625-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: