Provider Demographics
NPI:1245341528
Name:JEPPSON, DANEEN CONLEY (NP)
Entity type:Individual
Prefix:
First Name:DANEEN
Middle Name:CONLEY
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 3400
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3281
Mailing Address - Country:US
Mailing Address - Phone:801-387-3400
Mailing Address - Fax:801-387-3420
Practice Address - Street 1:4403 HARRISON BLVD STE 3400
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3281
Practice Address - Country:US
Practice Address - Phone:801-387-3400
Practice Address - Fax:801-387-3420
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1983184405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS91480Medicare UPIN