Provider Demographics
NPI:1932380839
Name:SANONE, SELANIE ANN (DNP)
Entity Type:Individual
Prefix:
First Name:SELANIE
Middle Name:ANN
Last Name:SANONE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W. 100 N.
Mailing Address - Street 2:STE. 210
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9826
Mailing Address - Country:US
Mailing Address - Phone:435-755-6061
Mailing Address - Fax:435-994-8362
Practice Address - Street 1:325 W LOGAN RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:UT
Practice Address - Zip Code:84028-7754
Practice Address - Country:US
Practice Address - Phone:435-755-6061
Practice Address - Fax:435-994-8362
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1645A363L00000X
IDCS53119363L00000X
UT219632-4405363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY125603300Medicaid
WY21693Medicare PIN
WY125603300Medicaid