Provider Demographics
NPI:1134692981
Name:ACORD, SHANNA L (PA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:L
Last Name:ACORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2321 N 400 E STE 200
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3440
Mailing Address - Country:US
Mailing Address - Phone:435-830-6110
Mailing Address - Fax:
Practice Address - Street 1:2321 N 400 E STE 200
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3440
Practice Address - Country:US
Practice Address - Phone:435-830-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical