Healthcare Provider Details

I. General information

NPI: 1730175761
Provider Name (Legal Business Name): MARLEE K DALTON CNM, ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 N 400 E STE 203
TOOELE UT
84074-3413
US

IV. Provider business mailing address

2376 N 400 E STE 203
TOOELE UT
84074-3413
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-0599
  • Fax: 435-880-2039
Mailing address:
  • Phone: 435-882-0599
  • Fax: 435-882-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number264241-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number264241-4402
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2642414405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: