Healthcare Provider Details

I. General information

NPI: 1720034416
Provider Name (Legal Business Name): STEPHANIE PLUNKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 W 9800 S
SOUTH JORDAN UT
84095-4713
US

IV. Provider business mailing address

1868 W 9800 S
SOUTH JORDAN UT
84095-4713
US

V. Phone/Fax

Practice location:
  • Phone: 801-433-2873
  • Fax: 801-433-5734
Mailing address:
  • Phone: 801-433-2873
  • Fax: 801-433-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5212615-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: