Healthcare Provider Details

I. General information

NPI: 1104457522
Provider Name (Legal Business Name): DIXYANN SMITH RN, BSN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIXY FUHRIMAN

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6835051-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: