Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 9257631-4405 | UT |
NPI | 1184255952 |
---|---|
Provider Name | Tyler Scott Dunyon |
First Address | North Salt Lake, UT 84054-6002 |
Second Address | Murray, UT 84107-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2020 |
Last Update Date | 28/07/2020 |