Provider Demographics
NPI:1225197379
Name:DAHLE, MICHELLE M (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:DAHLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 W 7800 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4506
Mailing Address - Country:US
Mailing Address - Phone:801-282-2677
Mailing Address - Fax:801-282-2050
Practice Address - Street 1:3534 S 6000 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84128-2610
Practice Address - Country:US
Practice Address - Phone:801-969-6264
Practice Address - Fax:801-969-6333
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT190989-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ05415Medicare UPIN