Provider Demographics
NPI:1205051950
Name:FOX, JUANITA M (RN, CDE)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 E 1000 S
Mailing Address - Street 2:
Mailing Address - City:FT. DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84026-0160
Mailing Address - Country:US
Mailing Address - Phone:435-722-5122
Mailing Address - Fax:435-725-6849
Practice Address - Street 1:6822 EAST 1000 SOUTH
Practice Address - Street 2:
Practice Address - City:FORT DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84026-0160
Practice Address - Country:US
Practice Address - Phone:435-722-5122
Practice Address - Fax:435-725-6849
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704175460163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator