Individual provider Active NPI

Nataliejo Dennis, APRN, FNP-C

  • Nurse Practitioner
  • Murray, UT
National Provider Identifier
1366264889
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9433350-4405 Issued in UT
Practice address
302 W 5400 S Ste 201
Murray, UT 84107-8237
Phone
(801) 456-2333
NPI assigned
Oct 28, 2024
Last updated
Nov 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9433350-4405 UT Primary

Addresses

Primary practice location

302 W 5400 S Ste 201
Murray, UT 84107-8237

Mailing address

11591 S Spring Stone Dr
South Jordan, UT 84009-8074
Phone (801) 368-1282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241112002726 UT Practitioner - Nurse Practitioner 6507390689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MMG LLCGroup PAC ID 5991039489, 7 clinicians

Practice addresses (Care Compare)

302 W 5400
Suite 200
Murray, UT 84107-8230
Phone (801) 456-2333

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MMG LLC Nurse Practitioner CurrentSince Nov 8, 2024 Accepting new patients
MMG LLC Nurse Practitioner CurrentSince Nov 8, 2024 Accepting new patients

Locations

302 W 5400 S
Ste 200
Murray, UT 84107
Phone (385) 297-9500

302 W 5400 S
Ste 201
Salt Lake City, UT 84107
Phone (801) 456-2333

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1366264889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11591 S SPRING STONE DR",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840098074",
            "telephone_number": "801-368-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W 5400 S STE 201",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841078237",
            "telephone_number": "801-456-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "NATALIEJO",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "9433350-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.