MEDICARE: DALLIN MARCHANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	8056069-4406	UT

General Provider Information

NPI Number	:	1083120059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLIN MARCHANT

Provider Business Mailing Address
First Line	:	1954 S 2600 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-3334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1954 S 2600 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-3334
Country	:	US
Telephone Number	:	801-599-0495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	11/20/2021

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Directions to “ DALLIN MARCHANT ” Practice Location

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