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General NPI Number Information
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NPI Number | 1194266148
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Entity Type | Individual
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Provider Name | SHANNA FOOTE
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Gender | Female
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 3197 S 2950 E
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City | ST GEORGE
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State | UT
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Zip | 84790-5134
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Country | US
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Telephone | 208-569-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 3197 S 2950 E
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City | ST GEORGE
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State | UT
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Zip | 84790-5134
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Country | US
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Telephone | 208-569-5666
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | APN0000022036
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License Number State | TN
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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 | 7968495-4405
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License Number State | UT
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