Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 11193762-4405 | UT |
N | 363L00000X | Nurse Practitioner | SP013990 | PA |
NPI | 1003213901 |
---|---|
Provider Name | Ann Shipley |
First Address | Pleasant Grove, UT 84062-3761 |
Second Address | Pleasant Grove, UT 84062-3761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2014 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SP013990 | CRNP FAMILY HEALTH (01) | PA |