Healthcare Provider Details

I. General information

NPI: 1124670872
Provider Name (Legal Business Name): NECIA DALLEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12391 S 4000 W
RIVERTON UT
84096-7012
US

IV. Provider business mailing address

7181 S CAMPUS VIEW DR STE 200
WEST JORDAN UT
84084-4312
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-1750
  • Fax: 801-302-1715
Mailing address:
  • Phone: 801-965-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8010164-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number8010164-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: