Healthcare Provider Details

I. General information

NPI: 1013412063
Provider Name (Legal Business Name): SHAE FRANCOM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 UNIVERSITY PARK BLVD
LAYTON UT
84041-1611
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-779-6200
  • Fax:
Mailing address:
  • Phone: 801-779-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8304537-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: