Healthcare Provider Details

I. General information

NPI: 1396575742
Provider Name (Legal Business Name): MORIAH DALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 E RIVERSIDE DR STE 101
ST GEORGE UT
84790-4454
US

IV. Provider business mailing address

1549 NORTHFIELD RD APT 48
CEDAR CITY UT
84721-7838
US

V. Phone/Fax

Practice location:
  • Phone: 435-900-1044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9808062-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: