Basic Information
| Provider Information | |||||||||
| NPI: | 1700104445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLRED | ||||||||
| FirstName: | SHANI | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 E LOIS CIR | ||||||||
| Address2: | |||||||||
| City: | MIDVALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016949320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 N MEDICAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015879500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2010 | ||||||||
| LastUpdateDate: | 05/05/2010 | ||||||||
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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 | 5129873-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.