1023105491 NPI number — MS. JENNIFER LYNN DUNNELL MSOT

Table of content: MS. JENNIFER LYNN DUNNELL MSOT (NPI 1023105491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023105491 NPI number — MS. JENNIFER LYNN DUNNELL MSOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNNELL
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSOT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023105491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1955 E 7000 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-942-3311
Provider Business Mailing Address Fax Number:
801-942-5955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 W VICTORY WAY
Provider Second Line Business Practice Location Address:
#103
Provider Business Practice Location Address City Name:
CRAIG
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-824-9359
Provider Business Practice Location Address Fax Number:
970-824-6777
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  208600 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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