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General NPI Number Information
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NPI Number | 1740697218
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Entity Type | Individual
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Provider Name | SHANE JONES FNP
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Gender | Male
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 09/01/2014
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Provider Practice Location Address
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Address Line | 1034 N 500 W
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City | PROVO
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State | UT
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Zip | 84604-3380
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Country | US
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Telephone | 801-357-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 9540 S CHINABERRY CIR
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City | SANDY
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State | UT
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Zip | 84092-3207
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Country | US
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Telephone | 435-632-0837
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6815878-4405
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License Number State | UT
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