Healthcare Provider Details

I. General information

NPI: 1932380839
Provider Name (Legal Business Name): SELANIE ANN SANONE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W LOGAN RD
GARDEN CITY UT
84028-7754
US

IV. Provider business mailing address

517 W. 100 N. STE. 210
PROVIDENCE UT
84332-9826
US

V. Phone/Fax

Practice location:
  • Phone: 435-755-6061
  • Fax: 435-994-8362
Mailing address:
  • Phone: 435-755-6061
  • Fax: 435-994-8362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1645A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCS53119
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number219632-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: