MEDICARE: SHANNON QUINN DUNLOP APRN

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	163WX0003X	Inpatient Obstetric Registered Nurse	6654802-3102	UT
2	363LF0000X	Family Nurse Practitioner	6654802-4405	UT

General Provider Information

NPI Number	:	1750624672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON QUINN DUNLOP APRN

Provider Business Mailing Address
First Line	:	1444 YUMA STREET
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108
Country	:	US
Telephone Number	:	801-828-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 S 3270 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119
Country	:	US
Telephone Number	:	385-261-2614
Fax Number	:	877-497-4661

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

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	02/06/2023

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