Provider Demographics
NPI:1578603932
Name:CLUNY, JOYLYN (MS NP)
Entity Type:Individual
Prefix:
First Name:JOYLYN
Middle Name:
Last Name:CLUNY
Suffix:
Gender:F
Credentials:MS NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 WEST 12600 SOUTH SUITE 2C
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:1801-446-2760
Mailing Address - Fax:801-446-2762
Practice Address - Street 1:13352 SOUTH 5600 WEST
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-8409
Practice Address - Country:US
Practice Address - Phone:1801-446-2760
Practice Address - Fax:801-446-2762
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1922334405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1578603932Medicaid