MEDICARE: MICHELLE M DAHLE FNP

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	363LF0000X	Family Nurse Practitioner	190989-4405	UT

General Provider Information

NPI Number	:	1225197379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M DAHLE FNP

Provider Business Mailing Address
First Line	:	3354 W 7800 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-4506
Country	:	US
Telephone Number	:	801-282-2677
Fax Number	:	801-282-2050

Provider Business Practice Location Address
First Line	:	3534 S 6000 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84128-2610
Country	:	US
Telephone Number	:	801-969-6264
Fax Number	:	801-969-6333

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2016

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