Basic Information
| Provider Information | |||||||||
| NPI: | 1366996910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNINGHAM | ||||||||
| FirstName: | JANA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 664 N 350 E | ||||||||
| Address2: | |||||||||
| City: | GENOLA | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846558187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013694537 | ||||||||
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| Practice Location | |||||||||
| Address1: | 852 EXPRESSWAY LN | ||||||||
| Address2: | |||||||||
| City: | SPANISH FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846601300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017947947 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2016 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 310758-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.