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General NPI Number Information
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NPI Number | 1083278717
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Entity Type | Individual
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Provider Name | SHANELL N RICH FNP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 3725 W 4100 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-5411
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Country | US
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Telephone | 801-965-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 14198 S CROWN ROSE DR
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City | HERRIMAN
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State | UT
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Zip | 84096-6497
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Country | US
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Telephone | 385-226-1059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 5801043-3102
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1083278717
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License Number State | UT
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