Provider Demographics
NPI:1437879251
Name:DUNFORD, NICCOLE VAUN (RN)
Entity Type:Individual
Prefix:
First Name:NICCOLE
Middle Name:VAUN
Last Name:DUNFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 N 860 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8698
Mailing Address - Country:US
Mailing Address - Phone:801-822-9444
Mailing Address - Fax:
Practice Address - Street 1:2392 N 860 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-8698
Practice Address - Country:US
Practice Address - Phone:801-822-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12103721-3102163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine