Healthcare Provider Details

I. General information

NPI: 1558040675
Provider Name (Legal Business Name): MARISSA ANN DUFUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 N THANKSGIVING WAY STE 206
LEHI UT
84043-4063
US

IV. Provider business mailing address

4161 N THANKSGIVING WAY STE 206
LEHI UT
84048-4063
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-9798
  • Fax:
Mailing address:
  • Phone: 801-830-0017
  • Fax: 385-324-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7870638-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7870638-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: