Healthcare Provider Details

I. General information

NPI: 1750624672
Provider Name (Legal Business Name): SHANNON QUINN DUNLOP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S 3270 W
WEST VALLEY CITY UT
84119
US

IV. Provider business mailing address

1444 YUMA STREET
SALT LAKE CITY UT
84108
US

V. Phone/Fax

Practice location:
  • Phone: 385-261-2614
  • Fax: 877-497-4661
Mailing address:
  • Phone: 801-828-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number6654802-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6654802-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: