MEDICARE: MS. SHELLEY SANDERSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	267385-4405	UT

General Provider Information

NPI Number	:	1962509786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY SANDERSON APRN

Provider Business Mailing Address
First Line	:	223 SOUTH 200 EAST STREET
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725-0370
Country	:	US
Telephone Number	:	435-878-2281
Fax Number	:	435-878-2434

Provider Business Practice Location Address
First Line	:	223 SOUTH 200 EAST
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725-0370
Country	:	US
Telephone Number	:	435-878-2281
Fax Number	:	435-878-2434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/02/2011

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