Healthcare Provider Details

I. General information

NPI: 1891083374
Provider Name (Legal Business Name): JEFFREY J DUNN DNP, ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD ST RESPIRATORY CRITICAL CARE - RICU
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5121 COTTONWOOD ST RESPIRATORY CRITICAL CARE - RICU
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-6475
  • Fax: 801-507-6491
Mailing address:
  • Phone: 801-507-6475
  • Fax: 801-507-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number285673-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: