Healthcare Provider Details

I. General information

NPI: 1366322570
Provider Name (Legal Business Name): SHAELLE PULLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W 1180 N STE 5
TOOELE UT
84074-1483
US

IV. Provider business mailing address

134 W 1180 N STE 5
TOOELE UT
84074-1483
US

V. Phone/Fax

Practice location:
  • Phone: 435-248-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12707785-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: