MEDICARE: SELANIE ANN SANONE DNP

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	363L00000X	Nurse Practitioner	NP-1645A	ID
2	363L00000X	Nurse Practitioner	CS53119	ID
3	363L00000X	Nurse Practitioner	219632-4405	UT

General Provider Information

NPI Number	:	1932380839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELANIE ANN SANONE DNP

Provider Business Mailing Address
First Line	:	517 W. 100 N.
Second Line	:	STE. 210
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9826
Country	:	US
Telephone Number	:	435-755-6061
Fax Number	:	435-994-8362

Provider Business Practice Location Address
First Line	:	325 W LOGAN RD
Second Line	:
City	:	GARDEN CITY
State	:	UT
Zip	:	84028-7754
Country	:	US
Telephone Number	:	435-755-6061
Fax Number	:	435-994-8362

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	09/13/2022

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