Provider Demographics
NPI:1114310802
Name:SHENK-FUEGI, SALLY (RN, MN, FNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SHENK-FUEGI
Suffix:
Gender:F
Credentials:RN, MN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 E. SOUTH TEMPLE
Mailing Address - Street 2:SUITE 508 DAVID A. MOORE, MD, PC
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-531-8634
Mailing Address - Fax:801-328-1737
Practice Address - Street 1:1002 E. SOUTH TEMPLE
Practice Address - Street 2:SUITE 508
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-531-8634
Practice Address - Fax:801-328-1737
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT211415-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily