Healthcare Provider Details

I. General information

NPI: 1235064569
Provider Name (Legal Business Name): SHAWNA MARIE DEMMITT A.P.R.N, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 S 860 W
PROVO UT
84601-6516
US

IV. Provider business mailing address

1247 S 860 W
PROVO UT
84601-6516
US

V. Phone/Fax

Practice location:
  • Phone: 801-623-8524
  • Fax:
Mailing address:
  • Phone: 801-623-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13189062-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: