MEDICARE: MEAGEN ALENE SHAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	11096132-4405	UT

General Provider Information

NPI Number	:	1902649635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGEN ALENE SHAW

Provider Business Mailing Address
First Line	:	1907 N 4100 W
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404-9725
Country	:	US
Telephone Number	:	801-618-9116
Fax Number	:

Provider Business Practice Location Address
First Line	:	3024 W 300 N STE C
Second Line	:
City	:	WEST POINT
State	:	UT
Zip	:	84015-7259
Country	:	US
Telephone Number	:	385-393-8224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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Directions to “ MEAGEN ALENE SHAW ” Practice Location

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