Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 6736118-4405 | UT |
NPI | 1003258252 |
---|---|
Provider Name | Dr. Shauna Albrecht Demars |
First Address | Kamas, UT 84036-9824 |
Second Address | Kamas, UT 84036-9824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 30/03/2020 |