Healthcare Provider Details

I. General information

NPI: 1003547845
Provider Name (Legal Business Name): ELIZA DANSIE PARKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZA DANSIE PARKIN APRN, DNP

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 S DALLIN ST
SALT LAKE CITY UT
84109-1119
US

IV. Provider business mailing address

2218 S DALLIN ST
SLC UT
84109-1119
US

V. Phone/Fax

Practice location:
  • Phone: 801-673-7088
  • Fax:
Mailing address:
  • Phone: 801-673-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number11765743-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11765743-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: