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NPI Code Detail

MEDICARE: MS. JEANETTE CROSBIE DAHL FNP-BC

MEDICARE: MS. JEANETTE CROSBIE DAHL 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
1363LF0000XFamily Nurse Practitioner5551683-4405UT

General Provider Information

NPI Number : 1578811220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANETTE CROSBIE DAHL FNP-BC
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5121 S COTTONWOOD ST
Second Line :
City : MURRAY
State : UT
Zip : 84107-5701
Country : US
Telephone Number : 801-507-3462
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2012
Last Update Date : 06/17/2026

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