MEDICARE: CINDIE G DODENBIER APRN, FNP-BC

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	363L00000X	Nurse Practitioner	268700-4400	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	268700-4405	OTHER	UT	PROFESSIONAL LICENSE
2	U000087610	OTHER	UT	LSPM PTAN
3	0360606	OTHER	UT	FNP-BC CERTIFICATION

General Provider Information

NPI Number	:	1578565263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDIE G DODENBIER APRN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 338
Second Line	:
City	:	ALTAMONT
State	:	UT
Zip	:	84001-0338
Country	:	US
Telephone Number	:	801-452-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 W 200 N
Second Line	:	SUITE 7
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-1861
Country	:	US
Telephone Number	:	801-546-1300
Fax Number	:	801-546-1301

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/07/2023

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